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

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On Sep 2018

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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

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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.
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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.
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Dr. Mamta Gupta
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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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Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : April | Volume : 16 | Issue : 4 | Page : ZC13 - ZC17 Full Version

Assessment of the Impact of Prosthodontic Intervention on the Oral Health Related Quality of Life among Post COVID-19 Mucormycosis Affected Individuals in Central India

Published: April 1, 2022 | DOI:
Vinay Dutta, Arun Khalikar, Sattyam Wankhede, Suryakant Deogade, Archit Kapadia, Pradyumna Doibale

1. Postgraduate Student, Department of Prosthodontics, Government Dental College, Nagpur, Maharashtra, India. 2. Professor and Head, Department of Prosthodontics, Government Dental College, Nagpur, Maharashtra, India. 3. Associate Professor, Department of Prosthodontics, Government Dental College, Nagpur, Maharashtra, India. 4. Associate Professor, Department of Prosthodontics, Government Dental College, Nagpur, Maharashtra, India. 5. Postgraduate Student, Department of Prosthodontics, Government Dental College, Nagpur, Maharashtra, India. 6. Postgraduate Student, Department of Prosthodontics, Government Dental College, Nagpur, Maharashtra, India.

Correspondence Address :
Dr. Vinay Dutta,
Postgraduate Student, Department of Prosthodontics, Government Dental College, Nagpur-440003, Maharashtra, India.


Introduction: The currently prevalent Coronavirus Disease 2019 (COVID-19) pandemic has amounted to various co-morbid conditions amongst patients and mucormycosis has been one among them. A globally emerging disease, this requires aggressive surgical treatment that necessitates due prosthetic rehabilitation.

Aim: To assess the impact of prosthodontic intervention on the Oral Health Related Quality of Life (OHRQoL) through Oral Health Impact Profile 14 (OHIP-14) questionnaire in post COVID-19 mucormycosis affected individuals.

Materials and Methods: The following study was a questionnaire-based prospective interventional study. The study population included post COVID-19 mucormycosis affected individuals who sought prosthodontic therapy for rehabilitation from the month of April 2021 to October 2021. The study instituted the questionnaire amongst 48 consenting participants. The OHIP-14 questionnaire was validated in their native languages and data was collected before and one month after prosthodontic intervention. Data was statistically analysed by the Wilcoxon signed-rank test.

Results: For all the individual questions, OHRQoL impact showed a significant decrease following prosthetic intervention (p-value <0.05). Total OHIP score also showed a significant decrease post-treatment (p-value=0.001).

Conclusion: Percentage improvement of OHRQoL ranging from 34.79-59.86% post prosthodontic intervention was observed. Thus, the impact of prosthodontic therapy among post COVID-19 mucormycosis affected individuals on the OHRQoL of the patient is positively significant.


Coronavirus disease 2019, Obturator, Oral health impact profile-14, Rehabilitation

Mucormycosis is one of the most enfeebling mycotic infections in the modern era. They are a class of angio-invasive fungal infections, origins of which can be traced to filamentous fungi belonging to the Mucoraceae family. After Aspergillus, Mucorales fungi are the most commonly debilitating pathogens in patients with haematological disorders or patients who have undergone an organ-transplant procedure (1),(2). Additionally, Mucorales infections are increasingly recorded in diabetes mellitus-affected individuals (3),(4), after trauma or iatrogenic injury (5),(6) and have been associated with outbreaks following natural disasters. The spores of mucormycetes are present in soil, animal excreta and air, which can either be inhaled or inoculated in exposed wounds. They harbour reservoirs in the upper respiratory tract commonly and disseminate to affect the orbit and maxillary bones predominantly. Hence, of all its pathogenic variants, the rhinocerebral variant is the most prevalent, amounting to an approximate 30-50% of all cases of mucormycosis (7),(8).

Recently, the Indian subcontinent has witnessed a considerable rise in incidences of Mucormycosis among Coronavirus Disease 2019 (COVID-19) affected individuals (9), with an alarming rate of about 70 times than that of the rest of the world (10). Coronavirus Disease 2019 patients present with considerable neutropenia and lymphocytopenia that provide an immunologically-supressed breeding ground for the dissemination of mucormycotic fungi (11). Additionally, an escalating prevalence of uncontrolled diabetes cases (4) and concomitantly increased use of corticosteroid drugs (12),(13) as a palliative measure to mitigate the challenges of oxygen dearth during the COVID-19 pandemic, have supposedly contributed to the increased incidence of rhinocerebral mucormycosis. A study even claims that about 10-20% cases were attributed to burns of the mucous membrane, secondary to excess steam inhalation (14).

The treatment strategy usually instituted is antifungal therapy and radical dissection of all affected tissues, leading to defects of the maxillo-facial region that demand early prosthetic interventions (15),(16). These maxillofacial defects amount to various postsurgical hindrances such as difficulty in mastication, impaired speech and issues of nasal regurgitation that warrant due postsurgical care. Moreover, they leave a physiologically-debilitating and psychologically-impaired patient who needs to be socially, functionally and vocationally rehabilitated (17). Fabrication of a well-retained and functionally comfortable prosthesis contributes to the well-being of the affected individuals (18).

This study aimed to highlight the impact of a prosthodontic intervention and to assess any demography related significant variability on the Oral Health Related Quality of Life (OHRQoL) index, through Oral Health Impact Profile 14 (OHIP-14) questionnaire, as a measure of the rehabilitative efforts taken towards post COVID-19 mucormycosis patients in Central India.

Material and Methods

The present study was a questionnaire-based prospective interventional study. The study was an institutional based study on post COVID-19 mucormycosis affected individuals. Before performing the study, due ethical clearance was obtained from the Institutional Ethical Committee (Ref no- IEC/05/04). All post COVID-19 mucormycosis affected individuals who sought prosthetic rehabilitation between the months of April 2021 to October 2021, willing to participate were included in the study.

Inclusion and Exclusion criteria: Patients were re-assessed with the questionnaire one month after delivery of prosthesis and patients whose follow-up was completed before November 2021 were included in the study. No specific exclusion criteria were formulated, but patients unwilling to participate were excluded.

Consented post COVID-19 mucormycosis affected individuals (n=52) whose prosthodontic rehabilitation was done at Department of Prosthodontics, Government Dental College and Hospital, Nagpur, Maharashtra, India, were approached to enroll as subjects in this study. Following 4 drop outs, a total of 48 subjects were successfully enrolled to the study. Data analysis and interpretation was completed by December 2021. Additionally, along with their relevant demographic information, intraoral findings and the type of surgery performed for debridement were noted for all the participants. Extent of the defect was categorised based on the Armany’s classification of maxillary defects (19).

Oral Health Impact Profile 14 (OHIP-14) Questionnaire

The OHIP-14 index was translated into Marathi by a bi-linguistic translator and verified by the forward-backward technique (20),(21). Corroboration of its easy-to-understand language was done amongst a group of 40 individuals (above 30 years of age). The questions were close ended with answers rated on a 5-point Likert scale from 0-4 i.e., 0-never, 1-sometimes, 2-occassionally, 3-fairly often and 4-very often/daily (Table/Fig 1).

The subjects were asked to answer the validated questionnaire which was printed in the language of their choice. If any of the participants encountered any difficulty in comprehending the questions, they were explained without prompting towards any definite answer. Subjects were asked to answer the questionnaire before prosthodontic intervention and subsequently one month after the same. Data was tabulated and assessed for each question, the different domains of OHIP-14 (functional domain, physical pain, psychological discomfort, physical disability, psychological disability, social disability and handicap) and separately for completely edentulous and partially edentulous individuals. Percentage decrease of the scores for different domains of OHIP-14 was done using the formula given below.

Through this data the effect of prosthodontic intervention on the OHRQoL was assessed.

Statistical Analysis

The data thus obtained, was subjected to statistical analysis by the Wilcoxon signed-rank test and the probability value was determined. Statistical Package for the Social Sciences (SPSS) version 20.0 software was used. Level of significance was kept at 5%.


On a demographic perspective, the mean age of 48 participants was 50.35 years (ranging from 34-67 year) (Table/Fig 2). Of all the participants, majority were male subjects 41 (85.41%) and most of them presented with a history of diabetes mellitus 34 (70.83%). Among these patients there were 8 (16.66%) who were completely edentulous, while others were partially edentulous with some teeth worthy of providing retention and support to the prosthesis. Armany class I defect was the most commonly occurring 23 (47.96%) and the least occurring type was Armany class V defect (0) (Table/Fig 3). Diabetes mellitus type II was noticed majorly 34 (70.88%) within the study population.

For each question, the mean was calculated both pretreatment and post-treatment, upon which the Wilcoxon-signed rank test was applied. The Probability value (p-value) was evaluated for each question and checked for significance (Table/Fig 4). For all the individual questions, the OHRQoL impact showed a significant decrease following the treatment (p-value<0.05). Total OHIP score also showed a significant decrease post-treatment (p-value=0.001) (Table/Fig 4). Additionally, under each domain of OHIP index, individual scores were estimated to assess the impact of prosthodontic intervention on the OHRQoL. The participants reported less OHRQoL impact scores, following treatment/intervention in all the domains that were statistically significant (p=0.001) (Table/Fig 5). The percentage decrease of scores were assessed and the decrease ranged from 34.79-59.86% after prosthetic therapy. Separately, an assessment was made to check if there was any significant difference between completely edentulous and partially edentulous patients by the Wilcoxon signed rank test (Table/Fig 6), (Table/Fig 7). Among completely edentulous patients, the OHRQoL impact showed a significant decrease following treatment (p-value <0.05). Total OHIP score also showed a significant decrease post-treatment (p-value ≤0.05), except for the question that addressed the sense of taste, which showed no significant change (Table/Fig 6). Amongst partially edentulous patients, the OHRQoL impact showed a significant decrease following the treatment (p-value <0.05). Total OHIP score also showed a significant decrease post-treatment (p-value ≤0.001) (Table/Fig 7).


One of the most commonly occurring variant of mucormycosis is the rhinocerebral type, which affects the nasal and maxillary bone predominantly, causing necrosis of the affected regions. These individuals present with symptoms of facial pain, nasal outflow, and sinusitis with clinical signs of orbital inflammation and necrotic tissue in the affected region. As the condition progresses, patients suffer from metabolic derangements, uncontrolled diabetes with ketoacidosis, advancing to delirium and progressively leading to death (22). The radical debridement of the necrosed tissue leads to the formation of maxillofacial defects that adversely affects the psychological, physiological and socio-behavioural state of the individuals. A well fabricated obturator prosthesis is the treatment of choice in such cases, since it seals the defect, facilitating in better mastication, phonetics and aesthetics. Impairment of senses, functional disabilities and compromised aesthetics has a deleterious impact on the Quality of Life (QoL) (23),24],(25),(26). Nasal leakage of food through the obturator was a common complaint among individuals rehabilitated by an obturator (27). The size and extent of the defect plays a crucial role in determining the functional efficiency and success of the obturator (28). In this study, on comparing the pretreatment and post-treatment scores of the subjects, there was a shift of the Likert scale towards the lower scores symbolising the improvement of the general condition of the patient. The results of the study showed a significant percentage decrease in the scores after a prosthetic intervention, in comparison to the scores before any intervention among all the domains of OHIP-14 questionnaire. This reflects on the impact and importance of prosthodontic intervention in ameliorating the OHRQoL of the patients. However, both completely edentulous and partially edentulous patients showed significant decrease in the OHRQoL scores after prosthesis use.

Among 48 subjects, 34 (70.88%) reported a history of diabetes mellitus, which could thus be attributed as a contributing factor in the aetiopathogenesis of post COVID-19 mucormycosis. In a meta-analysis of 851 case reports, it was found that 40% of subjects suffering from mucormycosis also had diabetes mellitus as an ailment (29). Serum pH is acidic in diabetic ketoacidosis cases leading to iron release from proteins, which harbours the growing fungi (30). Improvement of the OHRQoL post-treatment could be accredited to good postinsertion counselling, easier mastication without nasal regurgitation, better expression of needs due to enhanced articulation of words or good social acceptance due to improved facial contours (31),(32).

The role of a prosthodontist in rehabilitating these patients with maxillo-facial defects, by an obturator is pivotal in creating an anatomical barrier between the oral and nasal cavities to enhance masticatory function, allow proper articulation of speech and render well-monitored healing of the surgically ablated tissues. Comparison between similar studies has been done in (Table/Fig 8) (33),(34),(35),(36),(37),(38). A proper knowledge of the tissue histology must be applied towards impression-making procedures, to appropriately approximate the prosthetic surface against the tissue surface at various stages of healing. Providing an interim obturator not only rehabilitates the affected individuals on a transient basis but also provides information about the practical challenges of the case and patient-specific prosthetic requirements (39). This information could be used to assist in the decision-making process for the definitive prosthesis, such as the use of various prosthetic retentive options, customisation of teeth positions based on aesthetic or functional needs.

This study brings to light the role of a prosthodontist in socially, functionally and psychologically rehabilitating individuals with maxillofacial defects and thereby improving the general condition and the QoL of the patient.


The sample selected was heterogenous on the grounds of age, gender or span of the defect which can be categorised as limitations of the study. Long-term assessment and follow-up of the same is required to probe any changes due to demographic variability.


Post COVID-19 mucormycosis has been a growing public-health concern during the COVID-19 pandemic and has caused significant morbidity, affecting the QoL of patients affected by it. Within the limitations of this study, the percentage improvement of the OHRQoL ranging from 34.79% to 59.86% post prosthodontic intervention was observed. Thus, the impact of prosthodontic therapy among post COVID-19 mucormycosis affected individuals on the OHRQoL of the patient was statistically significant.


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DOI and Others

DOI: 10.7860/JCDR/2022/52592.16206

Date of Submission: Dec 02, 2021
Date of Peer Review: Jan 12, 2022
Date of Acceptance: Feb 03, 2022
Date of Publishing: Apr 01, 2022

• 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

• Plagiarism X-checker: Dec 03, 2021
• Manual Googling: Feb 02, 2022
• iThenticate Software: Feb 11, 2022 (9%)

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