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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Analytical Study of Conjunctival Bacterial Flora in Diabetic and Non Diabetic Patients
Correspondence Address :
Sandip Samaddar
179,28/C, Santosh Roy Road, Kolkata-700008, West Bengal, India.
E-mail: drsandipSamaddar@gmail.com
Introduction: Conjunctiva is a transparent mucous membrane that lines inside of the eyelids and covers the sclera. It is composed of non keratinised, stratified columnar epithelium with goblet cells. Normal microbial flora constitutes organisms which are present in eyelids and conjunctiva without causing any disease. At birth eyes are sterile but they are later infected by various organisms. Gram positive organisms are mostly prevalent in ocular flora. Diabetes mellitus is a multifactorial disease that can affect all ocular structures.
Aim: To compare the microbial flora between diabetic and non diabetic patients and to study there sensitivity to antibiotics.
Materials and Methods: This was an analytical study conducted on a total of 100 patients attending Department of Opthalmology of Medical College and Hospital, Kolkata, India between June 2019 to July 2019. They were not using any topical ocular preparation. Conjunctival swab was taken from upper fornix of the patients and cultured and the results obtained were analysed using Chi-Square test.
Results: Conjunctival flora of a total of 100 patients, 30 diabetic and 70 non diabetic, were screened. Among the 30 diabetic patients, there were 15 (50%) male and 15 (50%) female. The most common isolated bacteria in diabetic and non diabetic groups were staphylococcus aureus (diabetic 70%, non diabetic 85.7%). There was a statistically significant difference in microbial flora pattern between the diabetic and non diabetic group. There was higher proportion of staphylococcus epidermidis among diabetic patients compared to non diabetic patients (p-value <0.01) and there was a higher proportion of staphylococcus aureus among non diabetics (p-value <0.01).
Conclusion: Present study found statistically significant difference in the microbial flora between diabetics and non diabetics. This will help the clinician to plan for the antibiotic prophylaxis before surgery for patients attending the Out Patient Department (OPD).
Antagonism, Antibiotic sensitivity, Conjunctiva, Eye drops, Oral antibiotics, Virulence
The conjunctiva is a transparent membrane that is present inside the eyelids and covers the sclera. Conjunctiva is composed of non keratinised, stratified squamous epithelium, adenoid layer and fibrous layer. Conjunctival glands include mucin glands like goblet cells and accessory lacrimal glands. The major function of the conjunctiva is to lubricate the eyes by tears and mucus and also act as a barrier against infection (1).
The conjunctiva that is sterile at birth becomes infected with several microbes acquired throughout life. Lactoferrin, lysozyme and Immunoglobulin A (IgA) that are present in tears play an important role in maintaining normal flora (1). Ocular microbial flora also depend on environment, age, immunity, climate, ocular surface disease and general hygiene conditions (2). Staphylococcus sp., Streptococcus sp. and Micrococcus sp. that normally protects against several pathogenic organisms are prevalent in human ocular flora (3). The majority of pathogens causing popstoperative endophthalmitis are from conjunctiva, eye lid and even nasal mucosa (4).
Diabetes mellitus is a multifactorial disease that can affect all ocular surface and even the retina (5). Diabetic endophthalmitis patients have a slightly lower vision than non diabetic endophthalmitis patients and may require vitrectomy more often (6).
This study was aimed to compare the microbial flora between the diabetic and non diabetic patients and know their pattern of sensitivity to antibiotics. Bacterial resistance is one of the most serious problems now-a-days. Knowing the sensitivity pattern of the bacteria will help us to plan our treatment accordingly.
This was an analytical study in which subjects were selected from patients attending OPD at Regional Institute of Ophthalmology (RIO), Kolkata, between June 2019 to July 2019 after consideration of inclusion and exclusion criteria and informed consent from the subjects. Total 100 patients (30 diabetic and 70 non diabetic) who came to RIO OPD with complaints other than eye infections were included. Ethical clearance was obtained for the same from RIO Kolkata.
Inclusion criteria: All patients without any pre existing ocular disease, not using any topical ocular preparation who were attending OPD on every Tuesday during the months of June 2019 and July 2019.
Exclusion criteria: Patient with pre existing ocular disease, patient using any topical ocular preparations and antibiotics, and those undergoing any major ocular surgery were excluded.
Procedure
The samples were collected from upper fornix of eyes by autoclaved swab sticks. The samples were transferred to sterile nutrient agar medium and incubated at 37°C for 3-5 days. Gram staining and Potassium Hydroxide (KOH) mount were then done for the inoculum of each plate.
Gram positive organisms found were staphylococcus sp, streptococcus sp and micrococcus sp. For gram positive cases catalase test and mannitol salt agar test were done.
Gram negative rods found were Escheria coli (E coli) and Klebsiella. They were further tested using phenol red lactose broth tests. Indole, Methyl Red (MR) positive but Voges-Proskauer (VP), citrate negative cases were cultured in Hi Chrome UTI Agar M1353 R. Indole, MR negative but VP, citrate positive cases were cultured in Hi chrome UTI Agar M1418. Mucoid purple colony gives confirmatory evidence of Klebsiella pneumonia.
In the diabetic patients’ eye swab, staphylococcus aureus and Klebsiella pneumonia were not found in same plate. So, to find out any antagonism between the two organisms, two containers of autoclaved nutrient agar were taken at a temperature of 50°C and inoculated with 50 mL broth culture of each organism. Each inoculated medium was taken in a petridish and left to solidify. Each such petridish was inoculated with 50 mL broth culture of second organism. Both plates incubated at 37°C for 24 hours.
Antibiotic sensitivity tests were done on nutrient agar plate by both antibiotic disc diffusion method (Oral antibiotics) and cup plate method (Liquid antibiotics) (7). The zone of diameter was measured in centimeter (cm). The antibiotics used were chloramphenicol, ciprofloxacin, tetracycline, polymyxin-B, rifampicin, co-trimoxazole, cephalexin and bacitracin used as discs. Moxifloxacin, Tobramycin and Gatifloxacin were antibiotic eye drops tested.
Susceptibility of microbes towards various stress conditions like heat, pH and Ultravoilet (UV) exposure were tested. Overnight broth cultures of microbes were incubated in water bath at 50°C for 10, 20 and 30 minutes for heat treatment. For pH treatment the pH of the medium was varied from 5, 8 and 10. For UV treatment microbes were UV exposed for 5, 10 and 15 minutes.
Statistical Analysis
All data were collected in a predesigned data sheet. Chi-square was applied to compare the study parameters between diabetic and non diabetic groups of patients. The result was considered statically significant when p-value was less than 0.05.
Conjunctival flora of a total of 100 patients, 30 diabetic and 70 non diabetic were screened. Among the 30 diabetic patients there were 15 (50%) male and 15 (50%) female patients and their mean age was 53.5 (±20.5) years. The mean duration of diabetes mellitus was 18 (±15) years. The non diabetic or control group included 43 (61%) male patients and 27 (39%) female patients and their mean age was 45 (±28) years. There was no negative culture amongst diabetic patients as compared to 5(7.14 %) among non diabetic patients (p-value=0.56). There was also no significant association between positive culture and duration (<1 year or >1year) of diabetes (p-value=0.30) and age (<55 years or >55 years) of the patient (p-value=0.16).
The microbial isolates are detailed in (Table/Fig 1). The most common isolated bacteria in both diabetic and non diabetic groups was staphylococcus aureus. There was a higher proportion of staphylococcus epidermidis among diabetic patients (43.3%) as compared to non diabetic (14.3%) patients (p-value=0.0031). There was a higher proportion of staphylococcus aureus among non diabetic patients (85.7%) as compared to diabetic patients (70%) (p-value=0.0043).
Antagonism among Microorganisms
In this study, no antagonism was found between the microorganisms Staphylococcus aureus and Klebsiella pneumoniae as shown in (Table/Fig 2).
Antibiotic Sensitivity Test
In this study, Staphylococcus aureus and Staphylococcus epidermidis isolated from the diabetic patients were more resistant than the same isolated from the non diabetic patients. Streptococci sp., Micrococcus roseus, E. coli isolated from the non diabetic patients were more resistant than the same isolated from the diabetic patients (Table/Fig 3), (Table/Fig 4).
Stress Condition Sensitivity Test
The results of stress condition sensitivity test can be represented by arbitrary scale analysis. From this analysis, we can compare the virulence of the microbes isolated from diabetic and non diabetic cases. In this analysis, virulence level in respect to 3 stress conditions (heat, pH and UV exposure) was considered. In this study, Staphylococcus aureus and Staphylococcus epidermidis has higher virulence as compared to Streptococcus sp., Micrococcus sp., E. coli, Klebsiella sp. The results are documented in (Table/Fig 5).
In this study, total 100 patients (30 diabetic and 70 non diabetics) were examined and their conjunctival flora was compared. The present study showed that staphylococcus aureus is the most common isolate in both the diabetic and non diabetic group, as is found by Adam M et al., (8). Ashtamkar S et al., found Staphylococcus epidermidis to be the most common organism (13.2%) isolated from diabetics (9). Study by Venkataraman M et al., showed coagulase negative Staphylococci as the most common organism in diabetics (10). Similar results were found in other studies (11),(12),(13),(14). Rajeshkannan R et al., found that gram negative organisms were more common among diabetics (15) which was opposite with the present study.
This study shows the prevalence of positive culture among diabetic patients that may be due to altered chemotaxis, adherence, phagocytosis, intracellular killing and bactericidal activity found in diabetes (16),(17),(18). Study by Rajeshkannan R et al., showed that diabetics had a positive culture of 68% as compared to non diabetics (15). Another study showed that the microbial growth in diabetic patients was 62.27% compared to 46.67% in non diabetics (19). Similar result was also found in study by Martins EN et al., (14). In the same study, age and gender had no effect on frequency of culture.
It was found that the frequency of gram negative bacteria was four times higher in diabetics with chronic rhinosinusitis than in non diabetic patients (20). In the present study, Klebsiella pneumoniae was most common among gram negative in diabetic patients (23.3%). In study done by Lim HW et al., the percentage was found to be 45.61% (21).
Previously several authors carried out antibiotic sensitivity tests. Long C et al., did antibiotic susceptibility analysis of microbes isolated between different time periods and showed that ciprofloxacin was the most effective against bacterial isolates, followed by cefoperazone during the first decade (1990-1999), but during the second decade (2000-2009) ceftazidime showed the greatest level of activity against most bacterial isolates, followed by cefuroxime. They also showed several gram negative organisms like P aeruginosa, B. proteus and E. coli were multidrug (gentamycin, neomycin, chloromycetin, ofloxacin) resistant (22). Study by Ashtamkar S et al., found Staphylococcus epidermidis was sensitive to gentamycin, vancomycin, linezolid (9).
Rajeshkannan R et al., studied antibiotic resistance to erythromycin, ampicilin, cephalosporin. They found that diabetics were more resistant to all three antibiotics (22.7%) compared to non diabetics (16.6%). Resistance of diabetics to erythromycin and ampicilin is 47.7% compared to non diabetics that is 36.6% (15). In another study, it was found that the gram positive staphylococci sp. has maximum resistance against erythromycin (38%) among the diabetic group and in the non diabetic group maximum resistance was seen with ampicillin (30%). The gram negative bacilli such as pseudomonas showed maximum resistance against ampicillin in both the groups (56%) (1). In the present study, usually topical antibiotics were preferred for ocular application due to its greater local concentration. Also, drops were more preferred over ointments normally as ointments were sticky and may hamper vision just after applying it. Hence, use of eye drops of antibiotics like moxifloxacin can be potential in clinical settings.
Limitation(s)
It was done on a limited number of patients over a short period of time. The study on the susceptibility of the organisms to stress conditions has to be done on a larger scale for better comparison. Authors plan to further continue this study on a larger scale.
The diabetic patients were more prone to ocular infection and hence it can be concluded that they must receive a more stringent antibiotic prophylaxis. Secondly, the study showed that the organism isolated from both the diabetic and the non diabetic patients were more sensitive to moxifloxacin, tobramycin and gatifloxacin. Hence, authors recommend the use of these drugs in antibiotic prophylaxis of patients before planned surgery.
10.7860/JCDR/2020/47457.15150
Date of Submission: Oct 26, 2020
Date of Peer Review: Dec 28, 2020
Date of Acceptance: May 25, 2021
Date of Publishing: Jul 01, 2021
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
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