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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
Assessment of Impact of Vitiligo and its Distribution on Psychosocial Life: A Cross-sectional Study
Correspondence Address :
Suganita,
Assistant Professor, Department of Dermatology, Rohilkhand Medical College and
Hospital, Bareilly, Uttar Pradesh, India.
E-mail: suganita123@gmail.com
Introduction: Vitiligo is a common depigmenting disorder of skin/mucosa. Its aetiology is multifactorial. Clinically, it presents as milky white macules as a result of loss of melanocytes from skin, hair or both. It does not cause any physical hindrance but can cause cosmetic deformity, which has a serious effect on patient’s quality of life.
Aim: To evaluate and compare the psychosocial impact on vitiligo patients having lesions on exposed and unexposed site using Vitiligo Impact Scale (VIS)-22.
Materials and Methods: A cross-sectional study was conducted on 70 vitiligo patients attending the Outpatient Department (OPD) of Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India, over a period of six months between October 2020 to March 2021. Patients were categorised into two groups i.e., exposed and non exposed group. VIS-22 scores were calculated and effect on quality of life in vitiligo patients was calculated. Demographic data and clinical characteristics were also documented. Appropriate statistical software, including Statistical Package for the Social Sciences (SPSS) version 23.0 was used for statistical analysis and Chi-square test was applied.
Results: A total of 70 patients (24 males and 46 females) were enrolled in this study who were similar in demographic profile. A mean VIS score in exposed group was 31.51 and in non exposed group was 21.45 which indicated large effect and moderate effect on their psychosocial life respectively. Mean score of each question was calculated, with highest mean score of 2.68, showing that patients were worried regarding the progression of disease. Most patients felt that others do not think that the disease spreads by touch and this was indicated by the mean score of 0.75.
Conclusion: In this study, it was seen that patients having lesions on exposed sites had a greater impact on quality of life, interpersonal relationships and patients felt more depressed as compared to those on non exposed sites.
Exposed, Non exposed, Psychological distress, Vitiligo Impact Scale-22
Vitiligo is a skin condition caused due to the destruction of melanocytes resulting in well-defined milky white patches (1). The prevalence of vitiligo in India has been found to be around 8.8% (2). Inspite of the fact that it does not cause any physical impairment, it has an immense effect on one’s appearance leading to a troublesome cosmetic deformity (1). Vitiligo patients have to encounter stigmatisation in day to day life from their family members, relatives, friends and colleagues (3). This can give rise to significant psychological problem in their everyday life. Patients have various degrees of emotional disturbances, including low mood, loss of pleasure, poor body image, poor self-care, low self-esteem and high stress (4). Severe depression can even result in suicidal tendencies (2).
The aetiology and pathogenesis of vitiligo is complex and multifactorial, including theories of autoimmune, genetic, neural, cytotoxic, biochemical, oxidative, melanocyte, inflammatory, and hormonal origin. Multiple susceptibility genes and various environmental triggers have also been associated in the pathogenesis of vitiligo (5). The quality of life is impaired in vitiligo patient due to the chronicity and relapsing nature of the disease. Vitiligo has a cynical influence on marital relationships and sexual life, which may end in divorce and physical abuse to the partner suffering from it. Wrong social beliefs like vitiligo is God’s punishment for the sins done in past life and many more exacerbate the problems of patients suffering from the disease. In India, sometimes vitiligo is considered as white leprosy, which has a significant stigma (6). A few people also believe that dietary restriction of certain food items will help to stop the progression of the condition, like some avoid taking milk and fish together or some stop taking sour food or rice in their diet.
The purpose of this study was to evaluate and compare the psychosocial impact and effect on day-to-day activities of vitiligo patients having lesions on exposed and non exposed site using VIS-22.
A cross-sectional study was carried out in the Dermatology OPD of Rohilkhand Medical College and Hospital, a tertiary hospital in Bareilly, Uttar Pradesh, India, between October 2020 to March 2021 after obtaining the Ethical Committee Clearance (IEC/71/2020/OCT). Convenient sampling was done and all patients who visited the Dermatology Outpatient Department within six months were included in the study. They were clinically diagnosed as having vitiligo by the consultant Dermatologist.
Inclusion criteria: Patients clinically diagnosed with vitiligo, aged 15-61 years, willing to be the part of the study were included.
Exclusion criteria: Patients with leukotrichia and those with any known medical co-morbidity like infections, other immunological disorders, or existing psychological disorder with ongoing treatment were excluded from the study.
Site of lesion was noted as being on areas that were exposed, which included lesions on face, neck, hands, forearms and feet and non exposed areas included lesions on the rest of the body. The body surface area of the lesion was not calculated, as the study was based on the site of the lesion, whether being exposed or non exposed and its effects on patient’s day-to-day life. A total of 70 patients were included in the study of which 35 were in exposed group while the rest 35 were in non exposed group.
All the patients were explained about the nature of study and informed consent was obtained from patients who were willing to participate in the study. Data collection was done from October 2020 to March 2021. The socio-demographic details of participants like age, sex, marital status, education and occupation were enquired. It also included details about vitiligo lesions like location and duration, and family history of vitiligo. VIS-22 questionnaire was used to assess and stratify impairment of vitiligo related quality of life (7). It was self-administered by the patients. There are 4 categories of responses to every item ranging from 0-3, which indicate how much vitiligo affects patient’s life:
• Not at all
• A Little
• A Lot
• Very much
Statistical Analysis
Coding, entry of the data, its clearing and compiling was done in Microsoft (MS) Excel sheets. Appropriate statistical software, including SSPS version 23.0 was used for statistical analysis and Chi-square test was applied. A p-value of <0.05 was considered statistically significant.
A total of 70 patients were interviewed. There were 24 males and 46 females in this study with the male to female ratio being 1:2.8 in exposed group and 1:1.3 in non exposed group. The age of the patients ranged from 17 years to 61 years with majority being in the 15 to 30 years age group for both the groups. Most of the patients in non exposed group were married (68.6%) while in exposed group, equal ratio between married and unmarried patients was observed. Illiteracy persisted in about 22.9% in 9 exposed group while in non exposed group it was 17.1%. In both the groups, most of the patients had completed their high school education. A negative family history of vitiligo was mostly seen in both the groups. Only a few patients had positive family history i.e., 11 (31.4%) and 14 (40%) in exposed and non exposed group respectively (Table/Fig 1).
The mean VIS score in exposed group was 31.51 and in non exposed group was 21.45 which indicated large effect and moderate effect on their psychosocial life, respectively. The overall mean VIS-22 score in the study participants was 26.48, significantly higher in exposed group.
Mean score of each question was calculated, with highest mean score of 2.6 (Q19), showing that patients were very worried regarding the progression of disease. The mean score of 0.75 (Q4) showed most patients felt that others do not think that the disease spreads by touch. On comparing the mean score of exposed and non exposed group, all questions had a higher mean score in exposed group, except Q.19, 20. Difference in the mean score of both these groups was highest (0.97) in showing patient of exposed group felt more helpless and dependent. Wearing clothes of choice was more problematic in patients of exposed group with difference of mean score 0.86. Mean of Q20 and Q22 was not considered as all participants were not eligible to answer those question (Table/Fig 2).
In this study, it was observed that vitiligo had a negative impact on a lot of quality of life indicators which included their dietary decisions, dressing style, interpersonal relationships with friends, family and partner. It was also noticed that patients had deteriorated their self-confidence due to cosmetic appearance. There was financial constraint observed among patients due to expenses and long duration of treatment. Patients were concerned regarding the spread of their vitiligo lesions, especially those who had progressive disease. Social isolation was quite troublesome for patients and a sense of insecurity and shame was observed among them.
In the present study, out of 70 patients, females were 65.7% and males were 34.3%. In both the groups, exposed and non exposed majority participants were females. These results were similar to the studies done by Salzes C et al., and Silverberg and Silverberg NB in which 62% and 71% were females and 38% and 29% males, respectively (8),(9). However, in studies conducted by Sawant NS et al., Wang KY et al., Pahwa P et al., more participants were males (2),(4),(10). The age range of participants in this study was 17-61 years out of which majority participants were young adults in age group 15-30 years. Similar findings were seen by Sawant NS et al., and Gupta V et al., (2),(7); whereas S¸????enov A et al., and Patvekar MA et al., showed more patients of middle age (1),(11).
In the present study, in non exposed group 68.6% of patients were married in comparison to exposed group which is present in 51.4% patients. This difference could be due to the vitiligo lesion present at exposed sites resulting in marriage rejections. Majority of the patients in study were married as observed by S¸????enov A et al., Patvekar MA et al., (1),(11) and while in contrast to study done by Aghaei S et al., most patients were unmarried (3). Positive family history was not seen in most of patients in this study and similar results were seen in studies done by S¸????enov A et al., Sawant N et al., and Patvekar MA et al., (1),(2),(11).
Educational status of most participants in our study was up till matriculation that is 40% and 42.9% in exposed and in non exposed, respectively; whereas in study performed by Bin Saif GA et al., majority of patients had an educational status till graduation (54.6%) and Amer A and Gao XH study revealed academic background of most patients uptill intermediate class (6),(12). Most patients enrolled in the present study were employed, out of which household work and professionals were the most common occupation observed. These findings were contrary to study done by S¸????enov A et al., where 44% of patients were unemployed (1).
The mean VIS-22 was calculated in the present study group and was found to be 26.48. A higher mean VIS-22 was observed in the exposed group which was 31.51. The findings were comparable to study performed by Patvekar MA et al., with a mean VIS-22 score of 32.57 and higher VIS-22 score of patients having lesions over face (41.23) and upper extremities (38.07) (11).
In the present study, patients were having lesions on exposed sites had a higher mean VIS-22 score which indicated more impact on their social life in comparison to those having lesions on non exposed sites. This was similar to the findings done by Zandi S et al., in which, those having lesions on head, face and neck and acral areas had mean DLQI score of 7.091 and 9.45, respectively in comparison to lesions on trunk having DLQI score of 7.4 (13). Contrasting results were observed by Ongenae K et al., where no co-relation between DLQI score and localisation of body site grouped according to visibility was found (14).
In the present study, mean score for domains like leisure and for interpersonal relationship, work, and school (Q12, Q21, Q22) was 1.07, 0.82 and 0.25, respectively and this was comparable to the study done by Wang KY et al., in which work and school was 0.97, leisure was 1.77 and interpersonal relationship score was 1.31 (4).
Limitation(s)
The sample size of the study was small and hence, did not reflect the prevalence of the general population. Study population included only adults and hence could not establish the findings in children. Further studies with a larger sample size can be conducted in future.
A considerable effect on quality of life was observed in patients having lesions on exposed sites and they felt more depressed as compared to those having vitiligo lesions on non exposed sites. Expenses for treatment and fear of spreading of disease to other sites had similar effect on both the groups.
DOI: 10.7860/JCDR/2022/51998.15958
Date of Submission: Aug 26, 2021
Date of Peer Review: Sep 27, 2021
Date of Acceptance: Jan 02, 2022
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
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