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

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On Sep 2018




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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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On Aug 2018




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MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
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.
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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
Consultant
(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.


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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.
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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

Important Notice

Original article / research
Year : 2011 | Month : August | Volume : 5 | Issue : 4 | Page : 711 - 713

The Prevalence of the Gastro Oesophageal Reflux Disease in Asthmatics

Spandana Charles, Priscilla Johnson, R. Padmavathi, Rajagopalan, A.S. Subhashini, Archana P. Kumar

Corresponding Author. Department of Physiology, Sri Ramachandra University, Chennai-600116. Department of Physiology, Sri Ramachandra University, Chennai-600116. Department of Chest Medicine, Sri Ramachandra University, Chennai - 600116. Department of Physiology, Sri Ramachandra University, Chennai - 600116. Department of Physiology, Sri Ramachandra University, Chennai - 600116.

Correspondence Address :
Dr. Spandana Charles,
Department of Physiology,
Sri Ramachandra University, Tamilnadu, India.
Phone: 9444957374
E-mail: spandanasolomon@gmail.com

Abstract

Background: Asthma and Gastro Oesophageal Reflux Disease (GERD) often coexist. The prevalence of GERD is estimated to be around 30-80% among asthmatics. GERD may worsen during an episode of airway obstruction and could also serve as a trigger for such an attack. The proposed mechanisms of GERD induced asthma include a vagally mediated reflex, micro aspiration and altered immune activity. As only limited information is available regarding its prevalence in asthmatics in developing countries such as India, this study was undertaken.

Aim of the Study: To estimate the prevalence of GERD in adult asthmatics

Settings and Design: This cross sectional study was conducted among asthmatics who were recruited from a tertiary centre in Chennai.

Methods and Material: This study was conducted among 86 asthmatics which included both males and females in the age group of 20-65 years. Known asthmatics who were diagnosed to be asthmatics at least a year ago, were included in the study. Smokers, subjects with a history of chronic obstructive pulmonary disease, tuberculosis, gastro intestinal malignancies and pregnantwomen were excluded from the study. A structured questionnaire was administered and GERD was determined if they had the typical clinical symptoms such as postprandial chest pain, heart burn, nausea and sour regurgitation.

Statistical Analysis Used: The data was analyzed by using the SPSS software. The prevalence rate was expressed in terms of percentage.

Results: The overall prevalence of GERD in asthmatics was 51.1%. The prevalence of GERD was higher in female asthmatics as compared to that in men. (56% vs 46%) The prevalence of GERD was higher in younger individuals as compared to that in the elderly.

Conclusion: This study has quantified the prevalence of GERD in individuals with asthma, and it has contributed to our understanding about the association between these two diseases. This study can be used to estimate the burden of GERD among asthmatics. Whether it is asthma that precedes GERD or whether it is GERD that precedes asthma has to be explored. This study stresses the need for patients with asthma to be evaluated for gastroesophageal reflux and to be treated with aggressive antireflux therapy to reduce the morbidity.

Keywords

Gastro oesophageal reflux disease, Asthma, Spirometry

Gastro-oesophageal reflux and asthma, both of which are common conditions often coexist and the association between the two has long been recognized, both mechanistically and epidemiologically (1). The global prevalence of GERD was reported to be around 30-80% among asthmatics (2) and it has been suggested that GERD may be a predisposing factor for the asthmatic episodes (3),(4). Both animal and clinical data suggest that gastro-oesophageal reflux serves as a trigger of bronchospasm and that it potentiates the bronchomotor response to additional triggers or both. GERD may worsen during an episode of airways obstruction and could also serve as a trigger for such an attack. The clinical relevance of this interplay continues to be explored, with special interest beinggiven to the role of GERD in the worsening of asthma. Although several studies have been conducted to estimate the prevalence of GERD and asthma independently in the general population, only limited information is available regarding the prevalence of GERD in asthmatics. Despite the enormous volume of literature that exists on this subject, there is a shortage of data in a developing country such as India. Hence, this study was conducted in Chennai to estimate the prevalence of GERD in asthmatics, which in turn may pave way to calculate the burden of this disease in asthmatic individuals. This study may not only serve as a platform to elucidate the pathophysiological relationships between asthma and GERD, but it may also help in exploring the links between the treatment of GERD and asthma.

Material and Methods

This cross sectional study was conducted among 86 asthmatics which included both males and females in the age group of 20-65 years. All the study subjects were recruited from the outpatient department of a tertiary centre in Chennai. The diagnosis of asthma was established both clinically (characteristic history of variable wheezing, cough and breathlessness) and by spirometry (evidence of reversibility on spirometry with > than 15% of FEV1 after salbutamol inhalation). Known asthmatics who were diagnosed to be asthmatics at least a year ago, were included in the study. Smokers, subjects with a history of chronic obstructive pulmonary disease, tuberculosis and gastro intestinal malignancies and pregnant women were excluded from the study.

The study participants gave their consent prior to the study. A structured questionnaire for evaluating GERD was administered to the study participants. The presence of GERD was determined in accordance with the standards which are given below: typical clinical symptoms of GERD such as postprandial chest pain, heart burn, nausea and sour regurgitation.

Statistical Analysis The data was analyzed by using the SPSS software and the statistical significance was estimated. The prevalence rate was expressed in terms of percentage. The Chi square test was used to estimate the statistical significance. P values which were less than 0.05 were considered as significant.

Results

This cross sectional study was conducted among asthmatics and the descriptive characteristics of the study subjects are provided in (Table/Fig 1). Most of the study subjects were under 45 years of age with a third above 45 years. Overall, 51.1% of the study participants (of the 86 subjects) were diagnosed to have GERD.

(Table/Fig 2) provides the prevalence rates of GERD among several subcategories within the study subjects. Although the difference in the prevalence of GERD across the subcategories was not statistically significant, we have described the differential prevalence across the select subcategories to illustrate the potential contributions from other risk factors. The prevalence of GERD was higher in women asthmatics (55.8%) as compared to that in asthmatic men (43%). The prevalence of GERD was higher in younger individuals from the age group 20-44 yrs (57.1% vs 43.3%) as compared to that in the elderly (45-60 yrs). Individuals who had asthma for more than 5 yrs had a higher prevalence of GERD as compared to the asthmatics with a history of shorter duration (59% vs 43%), although the difference was not statistically significant.

Discussion

This epidemiological study was carried out for estimating the prevalence of GERD, as there have been only few prevalence assessments for GERD in our geographical location, especially among asthmatics. A majority of the studies have been conducted in the general population. Although the studies vary in their criteria for diagnosing as to what level of symptoms were pathological, the symptoms of GERD appear to be more common among the asthma populations as compared to a 35 to 40% incidence which was reported for the general population. The clinical features were almost the same between normal GERD and asthma induced GERD, except for the fact that the asthmatics had GERD symptoms following episodes of asthma and after taking anti asthmatic medication.

The overall prevalence of GERD was found to be 51.1% among the study subjects. The altered respiratory physiology in the asthma patients may predispose them towards GERD. Such a higher prevalence of GERD in asthmatics could be attributed to the following reasons. Respiratory obstruction can result in negative pleural pressures, thus increasing the pressure gradient between the thorax and the abdominal cavity and facilitating the movement of gastric secretions towards the lower oesophageal sphincter (LES), thus promoting reflux (5). Moreover, the diaphragm’s contribution to the sphincter tone is decreased in asthma. Furthermore, bronchodilator therapies (both beta-agonists and theophylline) appear to reduce the LES pressure and increase the pressure gradient across the LES, thereby promoting the development of GERD (6), (7). The GERD in asthma can be summarized as a reflux which leads to microaspiration, which occurs in persons with a heightened bronchial reactivity and an immune system modification (8). Obesity both in men and women can also predispose to GERD (9). The mechanisms which underlie the association between obesity and GERD are only partly understood. Obesity-related changes in the gastrooesophageal anatomy and physiology such as an increased prevalence of oesophageal motor disorders, a diminished lower oesophageal sphincter pressure, the development of hiatal hernia and increased intra gastric pressure might contribute to an explanation for this association. In women, oestrogen might also be involved in this association. The prevalence of GERD was found to be higher (57%) in asthmatics with a BMI which was > 30 as compared to that in asthmatics with a lower BMI (38%). But the difference was not statistically significant.( P value- 0.13).

There was no statistically significant difference in the prevalence of GERD between women and men. Similar results were obtainedby Dennis and Wang (10),(11) who stated that there was no specific gender difference in the prevalence of GERD. There was no statistically significant difference in the prevalence of GERD between young adults (20-45) yrs and older adults (45-60). The prevalence of GERD was more in asthmatics who had a longer duration of the disease, though it was not statistically significant, thus suggesting the interplay of asthma and GERD. This could be because of the frequent exacerbations of asthma and anti asthma medication use, which may have decreased the LES pressure.

Relevance As this was a cross sectional study which was aimed at estimating the baseline prevalence, the available evidence does not yet clearly indicate whether GERD precedes asthma or whether asthma triggers GERD. The recently published Montreal definition of GERD concludes that GERD can be an “aggravating cofactor” in asthma (12). Future research will further define the association between asthma and gastro oesophageal reflux.

Limitations of the study More sophisticated methods including barium oesophagogram, endoscopic examination, mucosal biopsy and the measurement of the LES pressure could not be done in this study due to logistic reasons.

Conclusion

This cross sectional study has quantified the prevalence of GERD in individuals with asthma and this baseline prevalence may serve as a platform to estimate the burden of the disease in vulnerable populations such as asthmatics. The higher prevalence of GERD in asthmatics highlights the existence of certain pathophysiological relationships between asthma and GERD, which have to be evaluated and explored in order to understand the association between these two diseases and to recognize the links betweenthe treatment of GERD and asthma. Moreover, this stresses the need for patients with asthma to be evaluated for gastrooesophageal reflux to be treated with aggressive anti reflux therapy and if required, to be subjected to anti reflux surgery in order to reduce the respiratory morbidity.

Key Message

Higher prevalence of GERD in asthmatics Asthma considered as a risk factor for GERD Proper management of asthma would reduce the incidence of GERD

References

1.
Osler WB. Principles and practice of medicine. Bronchial asthma. 1892; 497-501.
2.
Sontang SJ, O’Conell S, Kandelwall T et al. Most asthmatic patients have gastro oesophagal reflux with or without bronchodilator therapy. Gastroenterology. 1990;99:613-620 (http://www.ncbi.nlm.nih.gov/ pmc/articles/PMC2397596/pdf/postmedj00041-0039.pdf)
3.
Ruigómez A, Rodríguez LA, Wallander MA, Johansson S, Thomas M, Price D. Gastroesophageal reflux disease and asthma: a longitudinal study in UK general practice. Chest. 2005; 128: 85–93.
4.
Richter JE. Atypical presentation of gastroesophageal reflux disease. Semin Gastrointest Dis. 1997;8:75–89.
5.
Harding SM, Richter JE .The role of gastroesophageal reflux in chronic cough and asthma. Chest .1997;111:1389-1402.
6.
Jack CL, Calverly PM, Donelly RJ. Simultaneous tracheal and esophageal Ph measurements in asthmatic patients with gastro esophageal reflux. Thorax. 1995; 201-204.
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Crowell MD ZE, Lacy BE. The effects of an inhaled B2-adrenergic agonist on lower esophageal function: A dose-response study. Chest 2001;120:1184-1187
8.
Field SK. A critical review on the studies on the effects of simulated or real gastroesophageal reflux on pulmonary function in asthmatic adults. Chest 1999;115: 848-856.
9.
Nilsson M., Johnsen R., Ye W., Hveem K, Lagergren J. Obesity and estrogen as the risk factors for the gastroesophageal reflux symptoms. JAMA. 2003;290: 66-72.
10.
Dennis, Tardif C , Nouveu TA. Abnormal acid reflux in patients with GERD J. Gastroenterol 2005;40:11-14.
11.
Wang JH, Luo JY, Dong L Gong J. Epidemiology of gastro esophageal reflux disease. World Journal Gastroenterology 2004 ;10:1647-1651.
12.
Jaspersen, D, Kulig, M, Labenz, J, et al .Prevalence of extraoesophageal manifestations in gastro-oesophageal reflux disease: an analysis based on the ProGERD Study. Aliment Pharmacol Ther 2003;17:1515-1520.

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