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

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On Sep 2018

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Dr. Arundhathi. S
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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.
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
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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.

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.
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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.
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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

Original article / research
Year : 2022 | Month : August | Volume : 16 | Issue : 8 | Page : LC12 - LC17 Full Version

Association between Anxiety, COVID-19 Status and Symptoms of Patients attending Fever Clinic of a Tertiary Level COVID-19 Hospital, West Bengal, India: A Cross-sectional Study

Published: August 1, 2022 | DOI:
Mousumi Datta, Pushpak Das, Abhishek Reja

1. Assistant Professor, Department of Community Medicine, Medical College, Kolkata, West Bengal, India. 2. Junior Resident, Department of Community Medicine, Medical College, Kolkata, West Bengal, India. 3. Junior Resident, Department of Community Medicine, Medical College, Kolkata, West Bengal, India.

Correspondence Address :
Pushpak Das,
2 G C Bhattacharya Lane, Serampore, Hooghly-712201, West Bengal, India.


Introduction: The Coronavirus Disease-2019 (COVID-19) pandemic has caused considerable panic and anguish among the world’s population, including India. So, besides physical health, COVID-19 has considerably left its mark on mental health.

Aim: To describe the study population according to their clinico-social, demographic profile, the level of anxiety prior to COVID-19 rapid antigen testing, and to explore the determinants of anxiety among COVID-19 suspected patients.

Materials and Methods: A cross-sectional survey was conducted in June, 2021-August, 2021 with a sample of 197 adult participants attending the fever clinic of Medical College, Kolkata, West Bengal , India. The data collection tool used was a predesigned, pretested structured schedule where the level of anxiety was measured with the Generalised Anxiety Disorder-7 (GAD-7) self-administered questionnaire. Relevant frequencies, percentages, central tendencies, and dispersions were calculated.

Results: Total of 197 responses were analysed, the mean age of respondents was 44.43± 16.54 years with 58.4% male. Among the patients, 64.5% were vaccinated and around 50.3% of total patients were partially or fully vaccinated by Covishield. Of the 197 respondents included in the study, 11.7% had anxiety (GAD score ≥10) before Rapid Antigen Testing (RAT) and among the participants who tested positive (70 patients), 10 patients (14.3%) had anxiety. Education, occupation, number of the symptoms and the symptoms of sore throat, myalgia and joint pain were significantly associated with the anxiety level. Number of symptoms, joint pain, fatigue, weakness and current fever status was significantly associated with RAT positivity.

Conclusion: One out of every 10 patients attending fever clinic with suspected COVID-19 suffered from significant anxiety before the RAT test. These findings mandates linking counselling services with RAT testing facility at the fever clinic.


Anxiety, Coronavirus disease-2019 testing, India, Multiple logistic regression

The outbreak of novel coronavirus in Wuhan, China, started the deadliest pandemic of the present time. It caused severe pneumonia and the virus was named Severe Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) (1). Preliminary studies have shown that SARS-CoV-2 may exceed previous coronaviruses in terms of transmissibility (2),(3). As a result, COVID-19 has quickly evolved into a global pandemic as declared by the World Health Organization on March 11, 2020. The scale and severity of the COVID-19 pandemic have made public health globally vulnerable. The global spread of this potentially lethal disease has left the globe in disarray, even wreaking havoc on high-income countries (4).

The average incubation period is 5.2 days, with significant variance among patients (5), and it is possible that it can spread asymptomatically as well. Fever, chills, cough, coryza, sore throat, breathing difficulty, myalgia, nausea, vomiting, and diarrhoea are all symptoms of infection (6). Older people with medical co-morbidities are more likely to become infected, and their results are worse (6). Cardiac injury, respiratory failure, acute respiratory distress syndrome, and death all can occur in severe situations (7).

Not only physical health, COVID-19 has additionally left its mark considerably on mental health. Several previous studies that looked at the psychological impact of epidemics or pandemics like Severe Acute Respiratory Syndrome (SARS) and COVID-19 revealed high levels of mental distress among healthcare personnel and the general public, including panic attacks and psychotic symptoms (4). A better and timely understanding of the psychological responses to infectious disease outbreaks among the community is important for many reasons. First, the high prevalence of psychological morbidities has been documented among individuals who are directly or vicariously exposed to life-threatening situations (8). Second, the prevalence of such psychological morbidities within a substantial proportion of the community can impact the daily functions of the affected people and cause social and economic consequences, like lost job productivity and monetary hardships. Third, better safeguarding of the psychological health of the community through practical mental health intervention is crucial to help, prevent or ameliorate health care delivery disruptions during outbreaks (9).

The widespread social and economic disruption of the pandemic has created a psychosocial impact unparalleled in present times. All these have been additionally fuelled by information overloads of recent media platforms that have unrelentingly unfolded a combination of accurate as well as inaccurate information and even conspiracy theories that successively have had a psychological impact on the community. The mental health and psychosocial impact of COVID-19 has thus been far-reaching (10). With the given background for rationale of conducting a study, the authors planned to explore anxiety level of patients with the following objectives:

1. To record clinico-demographic profile of suspected COVID patients.
2. To determine the level of anxiety prior to COVID-19 rapid antigen testing.
3. To assess COVID-19 status using rapid antigen test.
4. To assess relation between RAT status and pre-test anxiety.
5. To explore the determinants of anxiety and RAT positivity among COVID-19 suspect patients.

Material and Methods

A cross-sectional observational study was conducted in the fever clinic of Medical College Kolkata, West Bengal, India, from June 2021 to August 2021. This institute was the referral centre for COVID-19 and catered largest number of COVID-19 patients in the state during the pandemic. The study protocol complied to the Helsinki declaration on bio-ethics policy and was approved by Institute Ethics Committee of Medical College, Kolkata with approval number MC/KOL/IEC/NON-SPON/1096/06/2021 dated 08/06/2021. Informed consent was obtained from all study participants.

Inclusion criteria: The research population included all adult patients suspected of COVID-19 attending fever clinic during the study time period.

Exclusion criteria: Patients who were critically ill, unable to understand English, Bengali or Hindi language and those who refused consent after reading adequate information about the study were excluded.

Sample size calculation: The minimum required sample size was determined to be 193 based on prevalence rate of anxiety of 14% among fever clinic attendees in Nepal as reported by Devkota HR. et al., (4) with 95% confidence, 5% absolute error. The final sample size of the present study was 197, sampling technique was systematic random sampling. The expected number of patients in the fever clinic per day was 80, target recruitment per day was 20. So, sampling interval was four. First patient was randomly selected between 1st and 4th patient using computer generated random number, the output was three so, hence every third patient was selected, till the sample size of 197 was reached. If the included patient had one or more exclusion criteria, then data was taken from next available patient.


The variables consisted of socio-demographic status of the patients (age, gender, educational status, residence, occupational status and family type), Disease related profile (Contact with suspected or confirmed COVID case in last 2 weeks, travel history in last 2 weeks, ever tested COVID positive or not and vaccination status), symptoms presented with and duration of the symptoms.

Questionnaire: The data collection tool used was a pre tested, pre designed structured schedule consisting of two parts. Part I captured data on socio-demographic variables, disease related profile and symptoms. Part II, the anxiety level before COVID-19 rapid antigen testing was measured using the Generalized Anxiety Disorder-7 (GAD-7) questionnaire (11). Bengali and Hindi versions of the questionaries were distributed among patients, with regard to the sample design of every third registered patient. Prior consent was taken and questionnaire were given while the respondents were waiting for the RAT test. Vernacular versions were translated and re translated, and their content, and semantic equivalence was checked by bi-lingual experts. The response options were: 0=“not at all”, 1=“several days”, 2=“more than half the days”, and 3=“nearly every day”. Time limit for these symptoms was within last 7 days. The total score ranged from zero to 21, with a higher score indicating more severe form of anxiety. For the GAD-7, a total score of ≥10 indicated possible anxiety, with the optimal point for sensitivity (89%) and specificity (82%) (12). In the present study, the Cronbach’s alpha coefficient of the GAD-7 was 0.792.

Statistical Analysis

Data was compiled into MS Excel version 10 spreadsheet. Statistical Package for Social Sciences (SPSS) software version 23.0 was used for statistical analysis. Frequencies and percentage were calculated for categorical variables and mean and standard deviation for continuous variables. Variables like age, educational status, occupational status, duration of symptoms and number of symptoms presented with were dichotomized for the purpose of calculation of Crude Odds Ratio (COR) and adjusted odds ratio (AOR) with their 95% confidence interval. COR was calculated by Chi-square and AOR by multiple logistic regression. Outcome variables were GAD 7 score categorised as < 10 (no intervention needed) and ≥ 10 (possible anxiety for which intervention was required).” No intervention needed” was used as reference category for the multivariate logistic regression model. All reported p values were considered statistically significant at <0.05.


The total completed responses analysed were 197, making the response rate of 100%. Mean age of the respondents were 44.43 (±16.54) years, with 58.4% being male, residing in urban areas (75.1%). Only 8.1% participants were previously diagnosed with COVID-19 and they at least had mean duration of fever for three days prior to their visit to the fever clinic. Among the patients 64.5% were vaccinated and around 50.3% were partially or fully vaccinated by Covishield, 13.2% were vaccinated with Covaxin and only 1 % of the patients received Sputnik V (Table/Fig 1).

Majority (85.8%) presented with fever which was mostly intermittent in nature and more or less equally distributed in between low and high grade (Table/Fig 2).

Of the 197 respondents included in the study 23 (11.7%) had moderate to severe anxiety(GAD score ≥10) before Rapid antigen testing (Table/Fig 3).

It was observed that 70 (35.5%) of the study population was RAT positive, among them 10 (14.3%) patients had anxiety. Anxiety was not associated with RAT positivity by Chi-square test (Table/Fig 4).

Among the demographic variables, education and occupation of the patients were statistically significant with the anxiety level. Adjusted odds ratio was significantly high for some symptoms like sore throat (p=0.014, AOR=0.008-0.578), myalgia (p=0.021, AOR=1.442-90.574) and joint pain (p=0.013, AOR=1.583-48.175) (Table/Fig 5).

Contact history of the patient (p=0.007) and their vaccination status (p=0.014) was statistically significant. Number of symptoms (p=0.006, AOR=1.867-40.961), joint pain (p=0.044, AOR=0.129-0.973), fatigue and weakness (p=0.004, AOR=0.064-0.578) and current fever status (p<0.001, AOR=2.420-21.487) of the patient was statistically significant with the RAT positivity (Table/Fig 6).


Present study provides important and timely data about the impact of COVID-19 on individuals’ mental and physical health. The level of anxiety prior to COVID-19 rapid antigen testing was 11.7% and it was significantly associated with the symptoms of sore throat, myalgia and joint pain.

The present study was done during and after the second wave of COVID-19 pandemic. During that time the patients came with major symptoms like fever (85.8%), sore throat (81.7%), myalgia (67%), and cough (76%). These findings are more or less similar with a study done in the early period of pandemic in Wuhan, China (6). Though there were also some new symptoms like anosmia and ageusia, the percentage of these symptoms were not high. However, later it was seen that these symptoms were also statistically significant with the test positivity. Hence, the authors could relate that these new symptoms are pathognomonic of COVID-19 which in turn portrays similarity with case-reports in Europe (13).

This study found 11.7% of the respondents with moderate to severe level of anxiety with the GAD-7 questionnaire according to which this said percentage of people are in need for intervention for their mental status. The disease burden discovered within the current study were not dramatically high compared to the recent studies conducted in different countries e.g. in China (14), and Italy (15) at the time of the pandemics. Prevalence of anxiety was higher than the background estimated national prevalence rate for anxiety with GAD which is 4.2% (16). During lockdown, a study conducted in India with the help of Depression, Anxiety and Stress Scale-21 (DASS-21) scale reported anxiety level of 10% (17) which is at par to the present study. Furthermore, a recent systematic review of COVID-19 and mental health literature indicated a prevalence of anxiety and depression ranging from 16% to 28% (18). Another population-based research intended at assessing depression and anxiety in Hong Kong residents during the COVID-19 pandemic discovered that 14% of the residents reported anxiety (GAD score ≥10) during the pandemic (8). In another cross-sectional survey conducted between May to June, 2020 across 26 hospitals in Nepal found that the prevalence of anxiety were 14% (4) though they had found that women were more at risk of anxiety. So, by comparing several studies it is clear that the anxiety level of the patient remained more or less same during the first and second wave of COVID-19 pandemic worldwide. High anxiety throughout the pandemic is problematic because a recent study found that coronavirus-related anxiety was strongly related to functional impairments, alcohol or drug coping, negative religious coping, extreme hopelessness, and passive suicidal ideation (19). Besides the present study findings are accordant with previous related studies, which exposed that public health emergencies like SARS (20), Ebola outbreak (21), earthquake (22) also causes severe mental health issues.

It is seen that during the time of recent pandemic that receipt of a COVID-19 positive result may cause a person to become traumatised, or in some way psychologically disordered, so after developing COVID-19 like symptoms the chance of a person becoming anxious is very high. For this reason, in the present study, the authors especially tested anxiety level before COVID-19 Rapid Antigen testing. As a positive result can make the person socially isolated which may impact on his or her day-to-day livelihood. Somewhat similar psychological distress precedes Human Immunodeficiency Virus (HIV) testing or receipt of an HIV positive test which can precipitate distress and anxiety. Rather than being prompted by an HIV test result, study discovered that discomfort and symptoms of depression and anxiety are part of the psychological profile of those seeking an HIV test (23).

The term infodemia was coined during the SARS outbreak, however, it is becoming comparatively more serious in the outbreak of COVID-19 infection (24). COVID-19 information overload has been characterized by contradictory information from different international and local authorities, experts, and scientists with different backgrounds, and mass media (25). During this pandemic it is seen that social medias like Facebook, Twitter is flooded with updates and latest information regarding COVID-19.Winning the race to share novel COVID-19 details and obtaining prominence on social media has expedited the propagation of false information during the current COVID-19 pandemic (26). So, this parallel global epidemic of misinformation-spreading rapidly through social media platforms and other outlets-not only poses a serious problem for public health but due to this massive information load, it also precipitated severe mental health issues.

To explore the regional variation of depression and anxiety during the COVID-19 pandemic cross-cultural studies must be considered. As the pandemic is not quite finished till now mixed method studies are very much needed for further evaluation of coping mechanism of people during pandemic. The data are very important to management of future pandemic.


The current study provides the preliminary subset of data about the impact of COVID-19 on mental health of patients attending a large tertiary care COVID-19 hospital. The results of the present study were limited by lack of generalisability due to unknown population denominator.


One out of every 10 patients attending fever clinic with suspected COVID-19 suffered from significant anxiety. This was associated with symptoms having high sensitivity of COVID-19, like anosmia and ageusia which were also associated with RAT positivity. Significant anxiety was also associated with sore throat, myalgia and joint pain which emphasises the need for surveillance of COVID-19 illnesses. However, pre-test anxiety was not associated with test positivity.


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DOI and Others

DOI: 10.7860/JCDR/2022/55403.16720

Date of Submission: Feb 04, 2022
Date of Peer Review: Feb 28, 2022
Date of Acceptance: Apr 27, 2022
Date of Publishing: Aug 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: Feb 07, 2022
• Manual Googling: Apr 18, 2022
• iThenticate Software: Jul 26, 2022 (16%)

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