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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
Rapid Plasma Reagin Card Test: A Screening Method for Syphilis in Antenatal Patients of Bastar, Chhattisgarh, India
Correspondence Address :
Dr. Ratna Agrawal,
Assistant Professor, Department of Pharmacology, Late Baliram Kashyap Memorial Government Medical College, Jagdalpur, Chattisgarh, India.
E-mail: ratna.arang@gmail.com
Introduction: Sexually Transmitted Disease (STD) like syphilis is one of the important factor leading to adverse pregnancy outcomes in antenatal mothers. The infant and neonatal mortality rate itself is higher in the tribal region of Chhattisgarh like Bastar due to poor educational status and limited availability of health infrastructures. To prevent the disease related adverse pregnancy outcomes, early diagnosis and treatment of STDs is important by rapid screening method like Rapid Plasma Reagin (RPR) card test, which is comparatively cost effective tool available at clinical settings.
Aim: To detect the incidence of syphilis among antenatal mothers of Bastar, Chattisgarh, India by using RPR card test.
Materials and Methods: The present cross-sectional study was conducted on 150 blood samples of patients attending Obstetrics and Gynaecology out-patient and in-patient Department (OPD and IPD) from August 2021 to October 2021. The samples referred to Microbiology laboratory of Late Baliram Kashyap Memorial Government Medical College Jagdalpur, Chhattisgarh, India, were tested by RPR card test taking all aseptic precautions. The data were collected in Microsoft Excel sheet and results were presented in counts and percentages using descriptive statistics.
Results: Out of 150 samples, 11 (7.33%) were tested positive by RPR card test while rest 139 (92.67%) were found negative. Out of the 11 (7.33%) samples which tested positive, 3 (27.27%) were from Anti Retroviral Therapy (ART) centre (concurrent Human Immunodeficiency Virus (HIV) and syphilis positive), 7 (63.64%) were from Obstetrics and Gynaecology OPD and 1 (9.09%) sample was from labour ward. Age of the patients attending antenatal clinic ranged between 11-50 years with maximum patients 103 (68.67%) were in 21-30 years of age group.
Conclusion: RPR card test is one of the important cost effective, rapid screening tools for STDs like syphilis, especially in the resource poor areas like tribal region of Bastar, Chattisgarh, India. Comparatively higher percentage of syphilitic infection reported in the study may contribute in improving health infrastructure policies in the affected regions of Bastar, Chattisgarh, India.
Sexually transmitted diseases, Slide flocculation test, Treponemal diseases, Tribal region
One of the sexually transmitted treponemal disease syphilis, affects around 1% or more of the antenatal population worldwide (1). In India, the estimated prevalence of syphilis is around 6% (2),(3). Although the accurate data of prevalence of syphilis in Bastar region is not available but, one study reported the prevalence of same among blood donors is around 1.48%, and the actual prevalence of the disease may be higher as blood donors are merely selected population (3),(4). Atleast half of the untreated pregnant women suffer from serious adverse events associated with syphilis, including still birth, neonatal or early infant deaths, prematurity and infants with congenital anomalies (1). The prevalence of infant and neonatal mortality rate in rural areas of Bastar are 45 and 29/1000 live births (5). Syphilis related infant and neonatal mortality can be prevented easily if every antenatal patient is screened at an early gestational period. So, every pregnant woman should undergo for a screening test for syphilis at her first antenatal visit and if there is high risk of exposure then they should be retested again at the third trimester and at the time of delivery.
There are a number of serological tests available, which fall under categories of treponemal and non treponemal tests. The non treponemal tests like Venereal Disease Research Laboratory (VDRL), RPR and Unheated Serum Reagin (USR) etc. which detect non specific reagin antibody by using cardiolipin antigen are used for screening purpose while the treponemal tests like Fluorescent Treponemal Antibody (FTA), FTA-absorption (FTA-ABS), Treponema pallidum Immobilisation (TPI) etc. which detect specific antibody by using Treponema pallidum specific antigen are used for confirmation of diagnosis (6).
The RPR and VDRL a slide flocculation test, both can be used for screening purpose but RPR is preferred over VDRL because: RPR antigen has prolonged shelf life, the sensitivity and specificity of the RPR card test is equal or better than VDRL test, materials required for RPR card test are easy to use, inexpensive and expendable and the test results can be read with naked eyes (7),(8),(9),(10),(11),(12),(13).
Owing to the high percentage of infant and neonatal mortality rate in Bastar region, Chattisgarh, India and inconsistent data regarding the prevalence of syphilis among antenatal population and due to the above mentioned advantages of RPR card test over VDRL test, the present study aimed to detect the incidence of syphilis among antenatal patients of Bastar, Chattisgarh, India by using RPR card test.
The present cross-sectional study was conducted on the specimens received in the Department of Microbiology, Late Baliram Kashyap Memorial Government Medical College Jagdalpur, Chhattisgarh, India, after obtaining informed consent from patients and approval from Institutional Ethics Committee (IEC). Convenience sampling was used. The study population comprised of IPD and OPD patients of Department of Obstetrics and Gynaecology for three months i.e. from August 2021 to October 2021 of the hospital.
Inclusion criteria: All antenatal patients visiting out patients and in patients Department of Obstetrics and Gynaecology, antenatal patients coming to labour ward and HIV-AIDS clinic of all age group were included in the study.
Exclusion criteria: Non pregnant patients attending out patients and in patients Department of Obstetrics and Gynaecology and HIV-AIDS clinic, women tested negative by urine pregnancy test and using contraceptive pills or other methods of contraception were excluded from the study.
Sample Collection and Preparation
The samples included all identification (patient’s full name, date of sample collected and the patient’s hospital identification number). Blood sample was drawn by using all aseptic precautions; the required sample was a minimum of 2.5 mL of clotted blood. The specimen was promptly centrifuged and an aliquot of the serum removed. Severely lipemic or homolysed serum was unsuitable for testing. Before testing, the serum was heated and inactivated at 56°C for 30 minutes. Inactivated serum was reheated at 56°C for 10 minutes, it tested more than four hours after the original inactivation.
RPR Antigen Suspension
RPR antigen suspension is stabilised combination of:
0.003% cardiolipin, 0.020-0.022% lecithin, 0.09% cholesterol, 10% choline chloride, 0.012 M Ethylenediamine Tetraacetic Acid (EDTA), 0.01875% charcoal, 0.01M Na2HPO4, 0.01M KH2PO4, 0.1% thimerosal in distilled water (14).
Control serum samples:
1. Positive control serum: Prepared from human serum samples containing antibodies to Treponema pallidum (14).
2. Reactive minimal control serum: Prepared from human serum samples containing antibodies to Treponema pallidum. Serum should be non reactive at 1:2 dilution, but reactive at 1:1 dilution (14).
3. Non reactive control serum: Prepared from human serum samples free of Treponema pallidum antibodies (14).
Diluent (control): 2% solution of human serum in 0.9% saline by diluting a human serum non reactive for syphilis 1:50 in 0.9% saline (14).
Methods
RPR is 18 mm circle card test (a macroscopic non treponemal slide flocculation test) for the qualitative and semiquantitative detection of plasma regain (14). The antigen suspension, a lipid complex, is agglutinated when mixed with samples containing reagin of patient affected by syphilis. Patients suffering from syphilis produce antibodies that react with cardiolipin antigen in a slide flocculation test which can be read using a microscope.
Qualitative Method (14)
One drop (50 μL) each, from the test sample, positive and negative controls was pipetted into separate reaction circles of the 18 mm circle of the RPR test card and was spread smoothly. A drop of diluted antigen suspension was added to the measured volume of sample, positive control and negative control each. The antigen was not spread or moved. The card was gently placed on an automatic rotator and rotated continuously at 180 rotations per minute (rpm) for 5-8 minutes. Following rotation, a brief hand rotation and tilting of the card (3-4 to-and-fro motions) was performed to aid in differentiating non reactive from minimally reactive results.
Interpretation of Results
Reporting of qualitative test was done after seeing the visible flocculation of the RPR card antigen suspension, which appears as black clumps against the white background, indicates a Reactive (R) specimen. Slight but definite clumping indicates a Minimally Reactive (Rm) specimen. In contrast, Non reactive (N) specimens appear to have a uniform grey colour. The flocculation seen in RPR card test by qualitative test is presented in (Table/Fig 1).
Any specimen exhibiting rough reactions has been quantitated using quantitative method as described by Pope V (14),(15).
Statistical Analysis
The data was collected in Microsoft Excel sheet and results were presented as count and percentage.
Out of 150 samples, 11 (7.33%) were tested positive by RPR card test while rest 139 (92.67%) tested negative. The age of the patients attending antenatal clinic ranged between 11-50 years with maximum patients [103 (68.67%)] were between 21-30 years with high positivity rate [8 (72.73%)]; as presented in (Table/Fig 2). The ward wise distribution of collected samples along with the positive samples by RPR card test is shown in (Table/Fig 3).
Syphilis is associated with many adverse pregnancy outcomes and owing to increased infant and neonatal mortality rate in Bastar region, the present study has been conducted to assess the incidence of syphilis among antenatal patients of Bastar using RPR card test. The incidence of syphilis in pregnancy was more (7.33%) in the present study as compared to study conducted by Murawala SM et al., (0.19-6.21%), Bala M et al., (0.3-4.4%) and Barot N et al., (0.5%) (16),(17),(18). The reason behind higher percentage of syphilis in the present study may be because of the study has been conducted in the tribal region of Bastar where education level of people is very poor (53.6%) and their knowledge about STDs is less (59.2%) (5). Some other studies carried out in India reported the prevalence of syphilis ranging from 1.8-3.4%, which is again lower than the present study (19),(20),(21). The decreasing trend of syphilis in above studies may be due to greater awareness and better education of women about the complications of syphilis related outcomes in pregnancy (19). The trend of syphilis prevalence reported in different regions of India by various previous studies has been presented in (Table/Fig 4) (16),(17),(18),(22),(23),(24),(25),(26),(27),(28).
Maximum number of positive samples 8 (72.73%) in the present study was from age group 21-30 years which was in accordance with the study conducted by Murawala SM et al., (21-45 years) and Barot N et al., (20-30 years) as syphilis is a sexually transmitted disease affecting more to adult population (16), (18).
Concomitant HIV and syphilis infection was reported in 3 (27.27%) out of 11 positive samples in the present study which was in corroboration of study conducted by Sethi S et al., where they also had reported rising trend (2.84-6.99%) of concurrent HIV and syphilis infection with increasing years (2006 to 2011) (25). Reason behind high percentage of HIV infection in antenatal clinic patients in present study may be due to higher prevalence of HIV in antenatal clinic patients of Chhattisgarh state (0.41%) as compared to other states (29).
As syphilis in pregnancy is associated with many adverse outcomes like infant and neonatal mortality, congenital syphilis etc, early diagnosis and treatment of the same is mandatory. The infant and neonatal mortality rate itself was higher in this region, so the early screening of the pregnant women for the disease like syphilis is important because it is easily treatable with penicillin. RPR card test provides the test results very fast and also due to its cost effectiveness, it has been added in essential diagnostic list by Indian Council of Medical Research (ICMR), even at Primary Health Centre (PHC) level (30),(31),(32), so it may prove as a useful aid in preventing STD related neonatal and infant mortality and morbidity.
Limitation(s)
There are some limitations of the study, like small sample size, inconsistent data about outcomes of pregnancies and co-existence of other infections etc., which may be addressed further in other studies along with comparing the RPR card test with other available screening methods (like automated RPR card test, VDRL, USR test etc.) for different STDs.
The STDs like syphilis leads to increased neonatal and infant mortality and morbidity. Comparatively higher percentage of syphilis infection reported in the study may contribute to the existing data of increased infant and neonatal mortality rate of Bastar District, Chattisgarh, India. RPR card test is an important cost effective and rapid screening tool for the disease like syphilis, which need early diagnosis and treatment to prevent adverse pregnancy outcomes, especially in the resource poor areas like tribal region of Bastar, Chattisgarh, India.
Authors are thankful to the technical staff of the Microbiology Laboratory for their constant support.
DOI: 10.7860/JCDR/2022/55082.16389
Date of Submission: Jan 20, 2022
Date of Peer Review: Feb 22, 2022
Date of Acceptance: Apr 07, 2022
Date of Publishing: May 01, 2022
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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