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

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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
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Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018

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On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"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."

Dr Kalyani R
Professor and Head
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Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

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Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
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

Important Notice

Case report
Year : 2012 | Month : August | Volume : 6 | Issue : 6 | Page : 1068 - 1069

Isolated Right Upper Eyelid Tuberculosis: A Case Report with Review of the Literature

Ranjan Agrawal, Sandeep Agarwal

1. Associate Professor, Department of Pathology, Rohilkhand Medical College Hospital, Bareilly, India. 2. Senior Resident, Department of Opthalmology, Rohilkhand Medical College Hospital, Bareilly, India.

Correspondence Address :
Dr. Ranjan Agrawal Associate Professor, Department of Pathology Rohilkhand Medical College Hospital Pilibhit Byepass Road, Bareilly Phone: 9412291009 E-mail:


We are reporting herewith a case of 54-year old lady who presented with a painless, peanut sized swelling in the right upper eyelid which was there since the past 2 months. No other local or systemic features were associated with it. An incisional biopsy was performed under local anaesthesia. The histopathological examination revealed an epithelioid granuloma with Langhans giant cells. The PCR test of the tissue confirmed the diagnosis of tuberculosis (TB). The patient was given anti-tubercular therapy and she is responding well, with the eyelid swelling being resolved.


Upper Eyelid, Tuberculosis, Granuloma, PCR

How to cite this article :

Ranjan Agrawal, Sandeep Agarwal. ISOLATED RIGHT UPPER EYELID TUBERCULOSIS: A CASE REPORT WITH REVIEW OF THE LITERATURE. Journal of Clinical and Diagnostic Research [serial online] 2012 August [cited: 2018 Oct 21 ]; 6:1068-1069. Available from

Ocular manifestations of tuberculosis are not uncommon in India, but tuberculosis of the eyelid is rather rare. Only a handful of cases have been reported in the literature, with the primary type being very unusual. Eyelid involvement is almost always secondary to the orbital involvement and it is often seen in the form of a drainage sinus (1).

Case Report

54-year old housewife who belonged to the upper middle socio-economic class presented with a swelling in the right upper eyelid. The swelling was observed 2 months back itself and it had gradually increased in size. There was no history of trauma over the site. There was no history of tuberculosis in the family, nor was there any definite history of exposure to any tuberculosis patient. The patient had a history of low grade fever since the past 3-4 months. She was diabetic and hypertensive and had been regularly taking medications for these ailments. On examination, a freely mobile, non-tender, peanut sized swelling which measured 5×8mm in size was found in the right upper eyelid (Table/Fig 1). The swelling was hard in consistency, along with lid oedema. There was no congestion and no restriction of the ocular movements. The best corrected visual acuity was 6/9. Both the eyes had normal intra ocular pressure. The sac, cornea, iris, pupil, lens and the fundus were normal. The left eye and the eyelid were normal. On general examination, the patient was found to be normal and healthy. There was no evidence of tuberculosis in any other site of the body. Clinically, a differential diagnosis of Chalazion or a parasitic infestation was thought of. The routine blood investigation revealed Hb -13.3gm%, TLC -6300 cells/cu mm and DLC- P-68, L-26, E-5 and M-1. ESR which was done by Wintrobe’s method was 53 mm in the 1st hour. The PPD test was positive with an in duration of 21 x 18 mm. The X-ray of the chest was normal. An excisional biopsy of the swelling was done under local anaesthesia and it was subjected to a histopathological examination. The H&E stained sections showed characteristic tubercles with central areas of caseation, which were surrounded by epithelioid cells, multi-nucleated and Langhans’ type giant cells and a cuff of mature lymphocytes and plasma cells (Table/Fig 2). The granulomas were distributed in between the meibomian glands as well. Occasional acid fast bacilli could be identified in the smears which were stained by the modified Ziehl-Neelsen’s method. Polymerase chain reaction (PCR) of the excised tissue which was done by using four standards, showed a positive DNA amplification, which confirmed the diagnosis of tuberculosis.

The patient was put on anti tuberculosis therapy and she has been found to be responding well during all the routine follow-ups. The operative site has healed up.


The definition of primary ocular tuberculosis is varied. Some authors use it to describe an ocular disease in the absence of a systemic involvement, while others use it to describe a disease in which the eye is the initial port of entry of mycobacterium into the body (2). It is very unlikely that tuberculosis of the eyelid may occur as a primary lesion per se. The systemic tubercle bacilli can disseminate haematogenously, giving rise to infections in almost every organ, including the eye. Orbital involvement by tuberculosis, even in endemic areas, is rare. The entry of the tubercle bacilli into the human-body may occur via the primary or the secondary routes. Cases of upper eyelid mycobacterial infection following oriential blepharoplasty (2),(3),(4) had been reported earlier; however, a primary involvement is very rare. The present case is an unusual manifestation of tuberculosis. Our patient presented with a painless, isolated eyelid swelling, which is extremely uncommon.

The tuberculin skin test is of limited value because of its low sensitivity and specificity. A presumptive diagnosis is commonly based on the finding of acid fast bacilli during a microscopic examination of the diagnostic specimen. A definitive diagnosis is dependent on a positive culture of the organism from the diagnostic specimen, which is time consuming. One of the most promising diagnostic techniques is the amplification and the detection of specific segments of the DNA of the tubercle bacilli by PCR, which is useful in diagnosing the disease with a high sensitivity and specificity.

The disease usually starts as a small nodule under the epithelium and when it occurs near the lid margin, it may resemble a stye or a chalazion. The nodule may ulcerate after some time and spread locally in an irregular fashion and it is often accompanied by pain and mucoid or at times, a purulent discharge (5). The disease is very insidious, and if it is left untreated, it can involve both the eyelids, and the resultant lid complications like ectropion can endanger the eye itself (6). Unlike that of systemic tuberculosis, the diagnosis of intraocular tuberculosis in most of the cases is based on the clinical features and the investigations alone and uncommonly on the histological and the microbiological evaluations.

In the present case, a possibility of chalazion was ruled out clinically, since the swelling was freely mobile. Ocular tuberculosis may present without demonstrable active tuberculosis elsewhere in the body. The most common ocular manifestations are anterior uveitis and choroiditis or chorioretinitis .Other intraocular manifestations which are attributed to TB include retinal vasculitis and Eales’ disease (3),(5),(6),(7).

The diagnosis can be difficult and it may necessitate an orbital biopsy in which acid-fast bacilli (AFB) and the characteristic histopathology may be seen. The growth of Mycobacterium tuberculosis from such a specimen remains the gold standard for the diagnosis of TB. PCR-based tests of the pathological specimens have been proven to be useful.

Ocular tuberculosis usually occurs in apparently healthy individuals who usually show evidence of only an old, healed or benign tuberculous lesion. It has been rarely observed in patients with active pulmonary disease. Both ocular and orbital tuberculosis are usually unilateral (5),(8).


It has been concluded that tuberculosis should be considered in the differential diagnosis of a chronic painless eyelid swelling, especially in the Indian background, where the disease still remains a main cause of morbidity. The diagnosis of the tuberculous pathology is important in order to start a specific therapy.


Liaquat J. Isolated Eyelid Tuberculosis. Uni Med Health Science. 2007; 6(1):37-39.
Madge SN, Prabhakaran VC, Shome D, Kim U, Honavar S, Selva D. Orbital tuberculosis: a review of the literature. Orbit. 2008; 27(4): 267-77.
Yang JW, Kim YD. A case of primary lid tuberculosis after upper lid blepharoplasty. Korean J Ophthalmol. 2004; 18(2): 190-5.
Chen SHT, Chun-Hua-Wang, Hang-Chi-Chen, Weng GCJ, Lin P-Y, Wei F-C. Upper eyelid Mycobacterial infection following oriental blepharoplasty in a pulmonary tuberculosis patient. Aseth Plast Surg. 2001;25:295-98.
Lynn WA, Lightman S. The eye in a systemic infection. Lancet. 2004; 364(9443):1439-50.
Sahu GN, Mishra N, Bhutia RC, Mohanty AB. The manifestations in ocular tuberculosis. Ind. J. Tub. 1998; 45:153.
Sheu SJ, Shyu JS, Chen LM, Chen YY, Chirn SC, Wang JS. Ocular manifestations of tuberculosis. Ophthalmology. 2001; 108(9):1580-5.
Shivananda PG, Srinivas Rao PN, Kotian, M, Nayak RG. Tuberculous granuloma of the left upper eyelid. Ind J Tuberculosis.1983; 30(1): 38-39.

DOI and Others

Date of Submission: Jan 16, 2012
Date of Peer Review: April 09, 2012
Date of Acceptance: May 25, 2012
Date of Publishing: Aug 10, 2012


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