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

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Dr. Mamta Gupta,
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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.
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Aug 2018

Dr. Rajendra Kumar Ghritlaharey

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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.
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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

Case report
Year : 2012 | Month : April | Volume : 6 | Issue : 2 | Page : 306 - 307

Culture Negative Infective Endocarditis Associated with Osler’s Nodes

Suindu K.N. Dash, C. Sugunakar, M.K. Kar

1. MD, Assistant Professor 2. MD, Assistant Professor 3. MD, Professor NAME OF DEPARTMENT(S)/INSTITUTION(S) TO WHICH THE WORK IS ATTRIBUTED: Department Of General Medicine, Kims, Amalpuram, Andhra Pradesh, 533201

Correspondence Address :
Dr. Suindu K.N. Dash, M.D., General Medicine
Assistant professor, Department of Medicine
KIMS, Amalapuram, Andhra Pradesh, 533201


Infective endocarditis is a form of endocarditis, or inflammation, of the inner tissue of the heart, such as its valves, caused by infectious agents. The agents are usually bacterial, but other organisms can also be responsible. The prototypic lesion of infective endocarditis the vegetation is a mass of platelets, fibrin, micro-colonies of microorganisms, and scant inflammatory cells. Infection most commonly involves heart valves (either native or prosthetic) but may also occur on the low-pressure side of a ventricular septal defect, on the mural endocardium where it is damaged by aberrant jets of blood or foreign bodies, or on intracardiac devices themselves. We studied one patient of rheumatic heart disease with fever, osler’s nodes and echocardiographic evidence of endocarditis but blod culture was negative. Patient was successfully treated with antibiotics. This article highlights the diagnostic utility of osler’s nodes in culture negative endocarditis.


Infective endocarditis, Osler’s nodes, Culture negative

Infective endocarditis is a form of endocarditis or inflammation of the inner tissue of the heart, such as its valves, caused by infectious agents (1). The agents are usually bacterial, but other organisms can also be responsible. The prototypic lesion of infective endocarditis, the vegetation is a mass of platelets, fibrin, micro colonies of microorganisms and scant inflammatory cells. Infection most commonly involves heart valves (either native or prosthetic) but may also occur on the low-pressure side of a ventricular septal defect, on the mural endocardium where it is damaged by aberrant jets of blood or foreign bodies, or on intra-cardiac devices themselves. The clinical syndrome of infective endocarditis is highly variable. Sometimes it becomes difficult to isolate the microorganisms responsible for endocarditis. Here we present a clinical case of culture negative endocarditis with osler’s nodes (1).

Case Report

A 55-year-old lady presented with complains of fever continuous type since 10 days. This was associated with joint pains. She developed reddish painful lesions over both the palms and feet for last 7 days. She had taken ofloxacin 400 mg orally twice daily without any relief. She had history of rheumatic heart disease since last 10 years. She had stopped penicillin prophylaxis for last 5 years. Patient was a housewife without any drug addiction.
Examination: The patient was febrile. Temp-1010F. Pulse-120/min, regular. BP-130/70mm of Hg. JVP was normal. All the peripheral pulses were well felt, bilateral symmetrical. There were tender red raised lesions found on the hands and feet. On auscultation over the precordium, 1st heart sound was loud and a mid diastolic murmur along with pan systolic murmur heard over mitral area.
Investigations: The routine blood investigations were as follows
ESR-25mm/1st hr
Urine microscopic examination showed 10-12 RBC/HPF
3times blood cultures 1 hr apart revealed no organism. Culture from osler’s node revealed no organism. ECG shows left atrial enlargement. Chest x-ray P-A view shows cardiac enlargement with mitralisation of left heart border. 2 D ECHOCARDIOGRAPHY showed moderate mitral stenosis with moderate mitral regurgitation along with two 7-8mm vegetations on the over surface of the valve. The above results suggested the diagnosis of infective endocarditis. The patient was treated with piperacillin with tazobactam and gentamicin 8 hrly for 1 month. The fever subsided after 7 days. The Osler’s nodes disappeared completely after 2 weeks of treatment. The patient was discharged after 1 month with penicillin prophylaxis and to consult CTV surgeon for MVR.


The incidence of endocarditis ranges from 2.6 to 7 cases per 100,000 populations per year (4). From 5% to 15% of patients with endocarditis have negative blood cultures; in one-third to one-half of these cases, cultures are negative because of prior antibiotic exposure. The remainders of these patients are infected by fastidious organisms, such as HACEK organisms, Coxiella burnetii, and Bartonella species (2). The clinical syndrome of infective endocarditis is highly variable and spans a continuum between acute and sub-acute presentations (5). The clinical features of endocarditis are nonspecific. However, these symptoms in a febrile patient with valvular abnormalities or a behavior pattern that predisposes to endocarditis (e.g., injection drug use) suggest the diagnosis, as do bacteremia with organisms that frequently cause endocarditis, otherwise-unexplained arterial emboli, and progressive cardiac valvular incompetence. The classic non-suppurative peripheral manifestations of sub-acute endocarditis are related to the duration of infection and, with early diagnosis and treatment, have become infrequent. In contrast, septic embolization mimicking some of these lesions (subungual hemorrhage, Osler’s nodes) is common in patients with acute S. aureus endocarditis. ESR is neither sensitive nor specific for diagnosis of infective endocarditis (1). Revised in 2000, the Duke criteria are a collection of major and minor criteria used to establish a diagnosis of endocarditis. A diagnosis can be reached in any of three ways: two major criteria, one major and three minor criteria, or five minor criteria (3).
Major criteria include:
1. Positive blood culture with typical IE microorganism, defined as one of the following:
a. Typical microorganism consistent with IE from 2 separate blood cultures,
b. Microorganisms consistent with IE from persistently positive blood cultures defined as:
i. Two positive cultures of blood samples drawn >12 hours apart, or
ii. All of 3 or a majority of 4 separate cultures of blood
iii. Coxiella burnetii detected by at least one positive blood culture or antiphase IgG antibody titer >1:800
2. Evidence of endocardial involvement with positive echocardiogram.
Minor criteria include:
1. Predisposing factor: known cardiac lesion, recreational drug
2. Fever >38°C
3. Evidence of embolism: arterial emboli, pulmonary infarcts, Janeway lesions, conjunctival hemorrhage
4. Immunological problems: glomerulonephritis, Osler’s nodes
5. Positive blood culture (that doesn’t meet a major criterion) or serologic evidence of infection with organism consistent with IE but not satisfying major criterion
Jane way lesions, Osler’s nodes, and Roth spots are more specific (but still not diagnostic) for infective endocarditis. They are also less common, and Roth spots are particularly rare. Janeway lesions are macular, blanching, non-painful, and erythematous lesions on the palms and soles. By contrast, Osler’s nodes are painful, violaceous nodules found in the pulp of fingers and toes and are seen more often in sub acute than acute cases of IE. In cases of culture-negative endocarditis, Osler’s nodes have been traditionally unhelpful in establishing the correct diagnosis, as they occur in only one-tenth of the cases (6). Determination of the pathogen in culture-negative cases has been dependent upon prolonged and scrupulous culturing techniques. Moreover, biopsy, culture, and microscopic investigations have been underutilized as diagnostic tools in infective endocarditis.Osler’s nodes represent micro emboli from vegetations in endocarditis. The microemboli may be septic or bland and can incite a variety of localized reactions in the microvasculature. Osler’s nodes, when identified, should be biopsied early and cultured for potential pathogens (5).


Kasper DL, Brunwald E, Fauci AS, Hauser S, Longo DL, Jameson JL. Harrison’s Principles of Internal Medicine. McGraw-Hill. pp. 1052–64, 18th edition 2011.
Cosgrove SE, et al. Initial low-dose gentamicin for Staphylococcus aureus bacteremia and endocarditis. Clinical Infectious Disease pp. 713, 2009.
Durack DT. Prevention of infective endocarditis, in Principles and Practice of Infectious Diseases, 7th ed, GL Mandell et al (eds). Philadelphia, Elsevier Churchill Livingstone, 2010, pp 1143–51.
Fowler VG Jr, et al:.Endocarditis and intravascular infections, in Principles and Practice of Infectious Diseases, 7th ed, GL Mandell et al (eds). Philadelphia, Elsevier Churchill Livingstone, 2010, pp 1067–12.
Habbib G, et al. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009). Eur Heart J 30:2369, 2009.
Murdoch DR, et al. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century. Arch Intern Med 169:463, 2009.

DOI and Others

DOI: JCDR/3829:1894

No competing Interests.

Date Of Submission: Dec 14, 2011
Date Of Peer Review: Dec 22, 2011
Date Of Acceptance: Jan 17, 2012
Date Of Publishing: Apr 15, 2012

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