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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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On Aug 2018




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Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
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
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

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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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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)
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

Important Notice

Original article / research
Year : 2022 | Month : February | Volume : 16 | Issue : 2 | Page : SC05 - SC07 Full Version

Clinico-immunological Study of HIV Infected Children Attending ART CentreA Prospective Longitudinal Study


Published: February 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/52417.15948
Kailash Chandra Soni, Preeti Verma, Priyanka Arya, Bhavana Tiwari, Tanu Midha, Sachin Chaudhary

1. Postgraduate Student, Department of Paediatrics, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India. 2. Postgraduate Student, Department of Community Medicine, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India. 3. Assistant Professor, Department of Paediatrics, Government Medical College, Kannauj, Uttar Pradesh, India. 4. Professor, Department of Paediatrics, Government Medical College, Kannauj, Uttar Pradesh, India. 5. Professor, Department of Community Medicine, Government Medical College, Kannauj, Uttar Pradesh, India. 6. Assistant Professor, Department of Community Medicine, Government Medical College, Kannauj, Uttar Pradesh, India.

Correspondence Address :
Dr. Preeti Verma,
Assistant Professor, Department of Community Medicine, Government Medical College, Kannauj, Uttar Pradesh, India.
E-mail: dr.preetivermakgmc2002@gmail.com

Abstract

Introduction: Human Immunodeficiency Virus (HIV) infection is a growing concern in paediatric population and large number of children are registered and treated at Antiretroviral Treatment (ART) centres across the country. Children with HIV progress more rapidly, develop more bacterial infections, suffer from neurologic developmental problems and have higher mortality than adults. So the screening and counselling of HIV positive parents and their children must be done timely. This helps the physician for starting the treatment timely.

Aim: To determine the clinico-immunological profile of paediatric patients registered in ART, and to compare the immunological profile and clinical staging of paediatric patients receiving ART.

Materials and Methods: This prospective longitudinal study was conducted in the ART centre of Sarojini Naidu Medical College, Agra, Uttar Pradesh, India, from October 2017 to October 2018. Total 51 children, upto the age group of 18 years, suffering from HIV/Acquired immunodeficiency syndrome (AIDS) were enrolled in the study. Diagnosis of HIV was confirmed using Enzyme-Linked Immunosorbent Assay (ELISA) method (using two different antigens Comb HIV test, TRI-DOT) in children more than 18 months of age. In children less than 18 months age, diagnosis was confirmed using Deoxyribonucleic Acid (DNA) Polymerase Chain Reaction (PCR) (repeated twice with cessation of breast feeding for minimum of six weeks). Statistical analysis was done by using Statistical Package for the Social Sciences (SPSS) trial version 23.0 and simple frequency and Chi-square test was used for analysis.

Results: Majority of the children (20, 39.26%) were in the age group of 5-10 years, and male:female ratio was 2.4:1. Most common presenting complaint was cough (52.94%), followed by fever (47.05%), chronic diarrhoea (37.25%). Most common clinical signs seen were hepatosplenomegaly (41.17%), pneumonia (33.33%) and lymphadenopathy (31.37%). Initially the mean CD4 count was 370.31±231.5 cell/mm3, and after starting ART mean CD4 count was 524.6±260.4 cell/mm3. Significant improvement in CD4 count was observed in age group of 5-10 years (p-value=0.009), and 10-15 years (p-value=0.001) after six months of starting the ART. In the beginning, maximum (56.7%) children belonged to World Health Organisation (WHO) clinical staging III and after starting ART maximum 40% belonged to stage II.

Conclusion: The ART improves symptomatology and immunological status HIV infected children, so there is need to screen the children of HIV affected parents and identify the children suffering with HIV in order to initiate ART at the earliest indication in order to improve their general health, freedom from illness and better immunological status.

Keywords

Antigens comb HIV test, Antiretroviral treatment, CD4 count, ELISA method, Human immunodeficiency virus, TRI-DOT test

The Human Immunodeficiency Virus (HIV) infection is a growing concern in paediatric population and large number of children are registered and treated at Antiretroviral Therapy (ART) centres across the country. Globally, an estimated 1.8 million children aged 0-14 were living with HIV at the end of 2019 and 150,000 children were newly infected. An estimated 100,000 children died of AIDS-related illnesses. Without access to testing and treatment, 50% of children with HIV will die by the age of 2 and 80% will not live to their fifth birthday (1). In 2019, at the national level, there were an estimated 23.49 lac (17.98 lac-30.98 lac) People Living with HIV (PLHIV), with an adult (15-49 years) HIV prevalence of 0.22% (0.17- 0.29%). Children Living with HIV (CLHIV) comprised 3.4% of the total PLHIV estimates (2).

As we know that CD4 T-lymphocyte is the immune system cell that HIV infects and destroys, and the CD4 count roughly reflects the state of the immune system. This suggests CD4 count is reliable marker of clinical status. Children with HIV progress more rapidly, develop more bacterial infections, suffer from neurologic developmental problems and have higher mortality than adults. Common clinical manifestations in children include fever, persistent diarrhoea, oral thrush, recurrent pneumonia, chronic parotitis, generalised lymphadenopathy, delay in development with failure to thrive, and significant pruritic dermatosis(3). Also, children with HIV infection suffer from opportunistic infections. The previous study (4),(5) which was conducted on HIV positive children, to see the improvement after initiation of ART, it was found that, those children who were initiated on ART had a significant improvement in both clinical and immunological staging at the six months follow-up. So, this study aimed at comparing the association of clinico-immunological profile of HIV infected children before and after starting ART.

Material and Methods

This was prospective longitudinal study conducted in the ART centre of Sarojini Naidu Medical College, Agra, Uttar Pradesh, India, from October 2017 to October 2018. After the ethical approval from the Ethical Committee of the College, 51 children were included in the study. Their parents/guardians were briefed about the objectives of the study and informed /written consent obtained before enrolling their children in the study.

Diagnosis of HIV was confirmed by Enzyme-Linked Immunosorbent Assay (ELISA), performed in the Department of Microbiology, using two different antigens (Comb HIV, TRI-DOT) in children more than 18 month. In children <18 month, diagnosis was confirmed by positive Deoxyribonucleic Acid Polymerase Chain Reaction (DNA PCR) (repeated twice with cessation of breast feeding for minimum of six weeks).

Inclusion criteria: All the children under 18 years of age who were registered in the ART centre, and whose parents gave voluntary consent for interview and were ready for follow-up were included in the study.

Exclusion criteria: Children parents who did not give written consent to participate in the study were excluded from the study.

Study Procedure

After confirmation of the diagnosis and after obtaining informed/ written consent from the parents or the guardian, child was enrolled for study. Further following steps were taken for performing the study:

Step 1: A complete demographic profile of the children was taken (age, sex, occupation of parents, socio-economic class, presenting complaint/symptoms, developmental milestones, personal history and habits,immunisation status, maternal birth and feeding history, any treatment history).

Step 2: A complete physical examination of the children was done (anthropometry, general physical examination, and systemic examination).

Step 3: Then the children were subjected to baseline investigations available at the hospital including- complete blood count, serum creatinine/blood urea (renal function), serum bilirubin, Serum Glutamic Pyruvic Transaminase (SGPT)/serum Glutamic-Oxalacetic Transaminase (SGOT), chest X-ray, Mantoux test, urine routine/examination and microscopic/examination, Erythrocyte Sedimentation Rate (ESR), blood sugar, Serum protein, Alkaline phosphate, Hepatitis C Antibody Test, Hepatitis B surface antigen).

Step 4: After the baseline investigation, for CD4 count of all the enrolled children, samples were tested by using Fluorescence Activated Cell Sorting (FACS) count (Bactec and Dickinson). After assessment on the basis of CD4 count and World Health Organisation (WHO) clinical staging children who were eligible for starting ART {according to National Aids Control Organisation (NACO) Guidelines} (3) were put on ART.

Step 5: Follow-up of patient:

• Follow-up of all the patients who put on ART was done every month, even in between a month period if patient was without any complaint and this follow-up was done for six months period. CD4 count of the patients was repeated after 6 months of follow-up (according to NACO Guidelines) (3).
• Patient was not eligible for ART was also followed-up every month for their clinical condition up to six months.
• Relevant investigation if needed (complete blood count, renal function, liver function etc.,) was carried out on the basis of clinicalassessment during the follow-up.

Statistical Analysis

Statistical analysis was done by using Statistical Package for the Social Sciences (SPSS) trial version 23.0 and simple frequency and Chi-square test was used for analysis. The p-value <0.05 was taken as significant cut-off value.

Results

In the study, majority of children 20 (39.26%) were in the age group of 5-10 years and male:female ratio was 2.4:1. (Table/Fig 1) shows that maximum 27 (52.94%) of children presented with cough, followed by fever (47.05%) and chronic diarrhoea 19 (37.25%). One (1.9%) child was asymptomatic, and was brought to the ART centre. (Table/Fig 2) shows that most common clinical finding was hepatosplenomegaly (21,41.17%) followed by pneumonia (17,33.33%).

(Table/Fig 3) shows, the immunological profile of the 51 children. In 0-5 years age group, mean CD4 was 655.71 (cells/mm3), in 5-10 years age group mean CD4 count was 371 and in >10-15 years age group mean CD4 count was 214.5 (cells/mm3). In the one child of age group 15-18 years CD4 count was 57 (cells/mm3).

Out of the 30 children who were put on ART, five were of 0-5 years of age, and their pre ART mean CD4 count was 753±464 (cells/mm3). After six months the CD4 count came down to 626±353.07 (cells/mm3), (p-value=0.1). Fifteen children were 5-10 years and their pre ART mean CD4 count was 450±335.29 (cells/mm3) which became 636.66±382.18 (cells/mm3), after six month post ART (p-value=0.009), that means there was significant increase in CD4 count after ART. Nine children were in age group of >10-15 years, their pre ART mean CD4 count was 221.22±126.95,which became 655.77±306.29 after 6 month post ART (p=0.001) shows significant improvement in CD4 count (Table/Fig 4).

According to (Table/Fig 5), 3 (10%) who were initially in stage I before ART, after six months remained in same stage I. Two (6.7%) children were in stage II before ART, six month post ART both children regressed to stage I. On the other hand, 15 (56.7%) children were in stage III before ART, out of these children, one child regressed to stage I, whereas 12 children regressed to stage II and four children still remained in stage III. Eight (26.60%) children were in stage IV, out of which three regressed to stage III and five still remained in stage IV.

Discussion

As we all know that, HIV disease progresses very rapidly in most young children, especially in the first few months of life, often leading to death. Without care and treatment, about one third of infants living with HIV will die in their first year of life and almost half of the children with HIV will die the second year of life. Globally, the number of children younger than 15 years living with HIV infection has increased from 1.6 million in 2001 to 2.5 million in 2009. In 2009 alone, globally, 370,000 children under the age of 15 years were newly infected. It was estimated that currently about 115,000 children are living with HIV in our country (3).

In this study, 39.26% children were in the age group of 5-10 years and male:female ratio was 2.4:1. The most common complaint was cough (52.94%), followed by fever (47.05%). The finding of this study was consistent with observations made in others studies (6),(7),(8),(9). Similar to others (6),(7),(8),(9) in the present study the most common clinical sign was hepatosplenomegaly (41.17%), followed by pneumonia (33.33%). In this study, the baseline mean CD4 count of 50 children was 324.38?190.46 cells/mm3 maximum was in 0-5 years (655?389.270 and least was in 15-18 years (57?0.0 cells/mm3). It indicates degree of immuno-suppression increased as the age of children increased. Similarly, Gomber S et al., studied the profile of HIV infected children from Delhi and their response to ART in 100 children who were brought for follow-up till six months (4). In their study they found that baseline mean CD4 count was 961.6?535.1 cells/mm3 in 1-5 years and lowest (422?226.3 cells/mm3) in above 13 years. This study also shows similar correlation with degree of immune-suppression and age.

In present study, we compare the pre ART CD 4 count of eligible children (n=30) with post ART CD4 count and we have found that the post ART mean CD4 count of these children increased to 524.6±260.4 cells/mm3 from baseline pre ART CD4 (370.31±231.5 cells/mm3) count. This significant increase in CD4 count was seen in 5-10 years (p-value <0.009), and 10-15 years age group (p-value <0.001) respectively. Similarly Natu SA and Daga SR, in their study found that after initiation of ART in 25 children older than 18 months, their mean CD4 counts was increased from 488/cmm to 765/cmm (p-value <0.001) (10). Memirie ST also found that the mean percentage of CD4 T-cells rose from 9.5% at baseline to 18.7 % at 6 months (p-value <0.001) in 50 subjects (11). Parakh A et al., conducted a study and they also found that the median CD4 increased from 6.0 % at baseline to 15.5% at six months (12). Therefore, our study is consistent with above studies.

In the present study, at the beginning maximum (56.7%) children belonged to WHO clinical staging III and after starting ART maximum (40.0%) improved to stage II. Gomber S et al., in their study on 100 children, found that on initiating ART there was significant improvement in both clinical and immunological staging at the 6 months follow-up (4). A study conducted by Verma SK et al.,on 50 children found that, initially 26 children were in clinical stage III which improved to clinical stage II and at first follow-up maximum increase in CD4 count was also seen in this stage (from 221.19±80.88 (cells/mm3) to 351.11±124.65 (cells/mm3)) (5).

Limitation(s)

Since NACO guidelines were followed for the selection of study subjects, the sample size was small (n=30). Due to constraint of resources, only one follow-up of study subjects was done for estimation of CD4 count.

Conclusion

There is improvement in the immunological status of the children who are taking ART recommended by the NACO. So, the children of HIV affected parents screened timely and identify the children suffering with HIV to initiate ART as early as possible to improve their general health, freedom from illness and better immunological status.

References

1.
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India HIV estimates (internet). 2019 (cited 2021 sep); Available at: http://naco.gov.in/sites/default/files/.
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DOI and Others

DOI: 10.7860/JCDR/2022/52417.15948

Date of Submission: Sep 17, 2021
Date of Peer Review: Oct 12, 2021
Date of Acceptance: Dec 14, 2021
Date of Publishing: Feb 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

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Sep 18, 2021
• Manual Googling: Dec 14, 2021
• iThenticate Software: Dec 27, 2021 (20%)

ETYMOLOGY: Author Origin

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