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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
Study of Colonisation Pattern and Antifungal Sensitivity Profile of Candida Species in Diabetic Patients
Correspondence Address :
Dr. Rakesh Tank,
Associate Professor, Department of General Medicine, SHKM Government Medical College, Nuh, Haryana, India.
E-mail: rakeshtank24@yahoo.com
Introduction: In recent times, various studies have pointed out the rise in prevalence of Candida species causing Urinary Tract Infections (UTIs). Candiduria appears to be underdiagnosed entity and thus has been the source of morbidity and mortality. Emergence of drug resistant Candida species has further complicated the patient management.
Aim: To understand the colonisation pattern and antifungal sensitivity profile of Candida species in diabetic patients.
Materials and Methods: This cross-sectional study was conducted for a period of six months (July 2019 to December 2019) at a tertiary care teaching centre of southern Haryana, India. A total of 360 urine samples were collected from patients admitted both out-patient and in-patient. Glycated Haemoglobin (HbA1c) ≥6.5% was taken as having diabetes. The urine samples were collected as per standard guidelines. Urine wet mount examination was performed. Confirmation of identification and antifungal susceptibility testing was done for all the Candida isolates. Data was analysed using statistical software.
Results: The prevalence of candiduria was 65 (18.1%) among study subjects. Out of significant candiduria patients 19 (29.23%) were having Candida albicans, 30 (46.16%) were Candida tropicalis, 10 (15.38%) were Candida krusei, 6 (9.23%) Candida glabrata. Candida albicans was found to be sensitive to amphotericin-B in 100% of cases. Sensitivity to flucytosine, voriconazole and fluconazole was found to be 89.47%, 89.47% and 84.21% respectively in case of Candida albicans.
Conclusion: The prevalence of candiduria is definitely high in this region. Non albicans Candida species are more resistant to antifungal drugs compared to Candida albicans.
Colony, Diabetes mellitus, Susceptibility, Urinary tract infection
Diabetes mellitus is a common and frequently encountered health problem among patients, many of them present with UTIs. In past 2-3 decades, various studies have pointed out the rise in prevalence of Candida species causing UTIs. Candida species is found to be responsible for 10-15% of nosocomial UTIs in Indian scenario (1). Not all cases of candiduria are diagnosed and reported hence it remains underdiagnosed entity and thus causes morbidity and mortality (2). All Candida species has potential of causing UTIs but as per the literature non albicans Candida species have replaced Candida albicans as the predominant pathogen (3).
Candida species are commensal under normal conditions but turns to pathogenic microorganism as defence system and mechanisms becomes weaker and may cause various kinds of infections in the body of host (4). Environmental conditions in the urinary tract of humans usually favour the growth of Candida species as observed in the literature (5). As per the available literature, higher susceptibility of fungal infections (including Candida species) to the the urinary tract of the host, is attributed to higher levels of urine glucose concentration in the host having diabetes (6). Pathogenic bacteria and fungi grow easily in any environment with raised levels of glucose concentrations.
Over a period of time irrational (prolonged and inappropriate) use of empirical therapy resulted in emergence of drug resistant Candida species that has further complicated the patient management. With this background, the present study was carried out to understand the colonisation pattern and antifungal sensitivity profile of Candida species in diabetic patients.
The present cross-sectional study was planned and rolled out under the aegis of Department of General Medicine in close collaboration of Department of Microbiology at a tertiary care teaching medical college situated at a lone aspiration district Nuh of southern Haryana, India. Study was conducted for a period of six months July 2019 to December. 2019. The study was instituted only after obtaining necessary clearance from Institutional Ethics Committee (IEC) of the medical college vide letter number SHKM/CM/2016/901 Dated 23.02.2016.
A total of 360 urine samples were collected from patients admitted both outdoor and indoor. Written informed consent was obtained from all the study subjects.
Inclusion criteria: Diabetic patients of both sexes and all age groups were considered for this study. HbA1c ≥6.5% was taken as having diabetes. Both OPD and IPD patients having urinary tract infections were included. Microbiologically, samples showing pure growth of yeast isolates with significant colony count were also included.
Exclusion criteria: Those urine samples in which Candida species was isolated but was not there, were excluded from this investigation. Similarly, those urine samples in which Candida with colony count was ≤1000 Colony Forming Unit (CFU)/mL and showing mixed growth (polymicrobial growth) were also excluded.
Sample size calculation: The calculation of sample size was done (n=360) considering the prevalence of Candida species causing vaginitis as 64.5% (7), with confidence level of 95% and 5% absolute error by applying the following formula: n=(Z1-a/2)2×p(1-p)/d2; where Z=Standard normal variate, a=Level of significance (0.05), p=Prevalence, d=Absolute allowable error (5%), n=sample size.
Study Procedure
The urine samples were collected as per standard guidelines (8). All samples were collected in containers that were sterile, leak proof and had screw capped lids. Samples were shifted to microbiology laboratory with no delay. Urine wet mount examination was performed. After that, urine samples were used for culture. Urine culture was done as per standard protocol (9). Samples were inoculated on Cysteine Lactose Electrolyte Deficient (CLED) and Mac Conkey agar. Incubation of culture plates was done at 37°C for 24-48 hours. Candida species isolated on culture plates with colony count >10000 CFU/mL were taken as significant (10).
Candida species were identified by inoculating isolates on Chromogenic (CHROM) agar. This was incubated for approximately 48 hours at 30°C. Observations were made as per manufacturers instruction (11). The identification of colonies was done on the basis of chromogenic reaction. Candida albicans was identified with Light green colonies on the CHROM Agar. Similarly Candida tropicalis was identified with blue colonies with pink halo, Candida glabrata was identified with cream to white colonies and Candida krusei was identified with purple fussy colonies on the CHROM Agar (12).
After that, confirmation of identification and antifungal susceptibility testing was done for all the Candida isolates using Vitek-2 compact system of biomerieux. The antifungal susceptibility was looked for amphotericin B, flucystosine, voriconazole, and fluconazole.
Statistical Analysis
Any possible personal identifiers were delinked with the data before the analysis. Data collected was entered in Microsoft excel 7, and then data was analysed using Statistical Package for the Social Sciences (SPSS) 22.0 statistical software. Descriptive values were expressed as mean and Standard Deviation (SD). Categorical variables were written as the numbers of cases and percentage value.
A total of 65 Candida species were isolated from 360 urine samples thus the prevalence of candiduria was 18.1% among study subjects. Out of significant candiduria patients, different species showed different pattern (Table/Fig 1).
Considering the age and sex distribution maximum percentage of significant candiduria was seen in age group 31-60 yrs of age (50.76%), with male being 33.84% and females being 16.92%. Followed by age group of greater than 60 years (30.77%), Male were 18.46% and females were 12.30%. In age group 1-30 years total of 18.46% were having significant Candiduria, Male 9.23% and Females 9.23% (Table/Fig 2).
Candida albicans was found to be sensitive to amphotericin B in 100% of cases. Sensitivity to flucytosine, voriconazole and fluconazole is shown in (Table/Fig 3).
In clinical isolates of Candida tropicalis sensitivity to amphotericin B, flucytosine, voriconazole and fluconazole is shown in (Table/Fig 3) respectively. Antifungal sensitivity pattern in case of Candida krusei with amphotericin B, flucytosine, voriconazole and fluconazole is shown in (Table/Fig 3) respectively. Antifungal sensitivity pattern of Candida glabrata with amphotericin B, flucytosine, voriconazole and fluconazole is shown in (Table/Fig 3) respectively.
More than 150 varieties of Candida species are currently existing around us as saprophytes. Majority of them are harmless, only a few are pathogenic for human beings. Candida infections are frequently encountered in the patients having diabetes mellitus. Present study observed a total of 65 Candida species isolated from 360 urine samples thus the prevalence of candiduria was 18.1% among study subjects. This was in contrast to the study from Madhya Pradesh that which observed the prevalence of candiduria as 65% among diabetic patients (7). On the other hand, another study from Bihar reported the prevalence of candiduria as 11.25% (13).
Authors observed higher prevalence of candiduria in this investigation. It is really important to note the rising burden of non albicans Candida species. This is a matter of concern that needs to be addressed (14). Certain factors are considered responsible for such rising trend of candiduria, a few of them are prolonged antibiotic therapy, prolonged hospital stay, immunocompromised status of patient, immunosuppressive therapy, catherisation, etc (15). Process of catheterisation involves migration of microbes from outer surface into the urinary bladder thus increase the chances of episodes of UTIs. Emergence of resistance for Candida indiscriminate is attributed to irrationale use of antifungal drugs, especially azole group (16). Immunocompromised state and critically ill patients are at high risk of developing candidemia (17).
Present study observed the isolation rate of non albicans Candida was 70.77% i.e. 46.16% were Candida tropicalis, 15.38% were Candida krusei, 9.23 % Candida glabrata. Various scientific reports have proved the rise in prevalence of non albicans Candida species among candiduria. Another study by Kumari KS et al., was also in concordance with present study observations (18). They observed that, of 500 urine specimens, 66 (13.2%) yielded Candida isolates whereas among the 66 Candida species isolated from urine, 43 were non-albicans Candida species and 23 were Candida albicans.
Regarding antifungal sensitivity profile and pattern of Candida species among study subjects, this study noted that Candida albicans was found to be sensitive to amphotericin B in 100% of cases. Sensitivity to flucytosine, voriconazole and fluconazole was found to be 89.47%, 89.47% and 84.21% respectively in case of Candida albicans. Identification of Candida species is important as non albicans Candida are more resistant to azoles compared to that of Candida albicans.
Candida krusei is intrinsically resistant to fluconazole. Present study also observed that antifungal sensitivity pattern in case of Candida krusei, antifungal sensitivity pattern with amphotericin B, flucytosine, voriconazole and fluconazole was 70%, 70%, 50% and 40% respectively. Antifungal sensitivity pattern of Candida glabrata with amphotericin B, flucytosine, voriconazole and fluconazole was 83.33%, 50%, 50% and 66.67% respectively. Antifungal susceptibility shows that Candida isolates were more susceptible to amphotericin B and flucytosine as compared to azole group. Clinicians commonly use azole group to treat candiduria thus increasing to fluconazole is noteworthy and challenging to us. Present study observed that Candida albicans were found to be more susceptibility to azole group compared to non albicans Candida. The result of this study was in agreement with previous study by Pramodhini S et al., (19). Understanding the colonisation pattern and antifungal sensitivity profile of Candida species are important for planning the management of such subjects. This adds to the strength of study investigation.
(Table/Fig 4) summarises the pattern of colonisation and sensitivity pattern as observed by various authors from different parts of India (13),(20),(21),(22),(23).
Limitation(s)
Due to financial and logistics constraints, authors could not perform comprehensive analysis of urine as samples of polymicrobial growth and pyuria were excluded.
The findings of this study shows that the prevalence of candiduria is definitely high in this region. Various species of Candida are responsible for causing UTI. Information on antifungal susceptibility pattern will help clinicians for better management of patients. Non albicans Candida species are more resistant to antifungal drugs compared to Candida albicans. Better understanding of colonisation pattern and antifungal sensitivity profile shall definitely help for better management of candiduria.
DOI: 10.7860/JCDR/2022/53341.16430
Date of Submission: Nov 17, 2021
Date of Peer Review: Jan 03, 2022
Date of Acceptance: Mar 04, 2022
Date of Publishing: Jun 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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