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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
Achromobacter xylosoxidans Subspecies denitrificans Endocarditis in a Patient with Prosthetic Aortic Valve: A Case Report and Review of Literature
Correspondence Address :
Dr. Chinmoy Sahu,
Department of Microbiology, C-block, Sanjay Gandhi Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
E-mail: csahu78@rediffmail.com
Achromobacter xylosoxidans subspecies denitrificans flourishes in presence of oxygen, commonly isolated from aquatic milieu. It is rarely implicated as the causative agent of endocarditis. It is not known to cause virulent infections in patients but causes severe infections in immunosuppressed patients with underlying co-morbidities. Present report is first case of Achromobacter xylosoxidans prosthetic valve endocarditis from India. This case report accounts for a 47-year-old man, suffering from Rheumatic Heart Disease (RHD), who presented to the cardiology emergency with chief complaints of remitting type high-grade fever for years years followed by persistent fever for 10 days. On echocardiography and positively flagged BACTEC blood culture reports was diagnosed as a case of Achromobacter xylosoxidans subspecies denitrificans bacteraemia and prosthetic aortic valve endocarditis. Antibiotics were started according to the susceptibility testing but the patient could not complete the course of treatment as he developed dyspnoea and cardiac arrest following which he could not be resuscitated.
Aortic regurgitation, Endocarditis, Immunocompromised patients, Matrix-assisted laser desorption/ ionization-time of flight-mass spectrometry, Mitral regurgitation, Rheumatic heart disease
A 47-year-old man who underwent prosthetic valve replacement surgery 18 years ago due to aortic regurgitation, presented to the cardiology emergency with chief complaints of remitting type high-grade fever for two years followed by persistent fever for 10 days. This patient was a follow-up case of RHD and infective endocarditis of prosthetic valve with chronic kidney disease, metabolic acidosis, and septic shock. His blood pressure was 107/60 mmHg, pulse rate was 96 beats/minute, and normal jugular venous pressure with metallic click sound of S1. Due to strong suspicion of valvular defect, he was advised for a two-dimensional echocardiography (2D-ECHO). His 2D-ECHO signs showed severe aortic and tricuspid valve regurgitation with moderate to severe mitral valve regurgitation and vegetations on the prosthetic aortic valve (Table/Fig 1)a-c. Three pairs of BACTEC bacterial cultures were sent to the Bacteriology Section of the Department of Microbiology within 24 hours to diagnose the causative pathogen (microbiological criteria) of Infective Endocarditis (IE). Two of the blood culture bottles flagged positive on the same day whereas the third bottle flagged positive the next morning. The microorganism isolated from all the blood culture bottles revealed growth of small pale-colored colonies on Mackonkey agar and non haemolytic colonies on blood agar (Table/Fig 2)a,b. Organism was recognised as Achromobacter xylosoxidans subspecies denitrificans by Matrix-Assisted Laser Desorption/ Ionisation-Time of Flight-Mass Spectrometry (MALDI-TOF-MS) assay. Kirby-Bauer disc diffusion method was used for performing antibiotic sensitivity testing which renders it susceptible to imipenem, meropenem, piperacillin- tazobactam, and cotrimoxazole. The patient was given the first two doses of intravenous piperacillin-tazobactam eight hourly for a day according to the antibiotic susceptibility but could not complete the course of treatment as he developed dyspnoea and underwent cardiac arrest on the same day before starting haemodialysis for chronic kidney disease. He was intubated for mechanical ventilation following cardiac arrest but despite all possible measures his blood pressure continued to fall and the patient went into cardiorespiratory arrest. Cardiopulmonary resuscitation procedures were performed as per protocol but the patient could not be resuscitated.
Achromobacter xylosoxidans subspecies denitrificans flourishes in presence of oxygen and is commonly isolated from aquatic milieu (1). It was acknowledged for the first time by Yabuuchi E and Oyama A in 1971, in pus samples obtained from ear infections in seven cases (2). This microorganism has been isolated as causative agent of central catheter infections, pneumonia, sepsis, meningitis, mediastinitis, and other hospital-acquired infections which may include outbreaks, but is rarely known to cause endocarditis (3),(4),(5).
Achromobacter xylosoxidans subspecies denitrificans stains negatively on Grams staining and is rarely implicated as the causative agent of endocarditis. Although it is known to cause several serious infections like sepsis, meningitis, and pneumonia, it rarely causes endocarditis (3),(4). It is not a highly virulent pathogen but immunocompromised patients are highly susceptible to the infections caused by them due to underlying co-morbidities and prosthetic valves (6),(7),(8).
The Duke criteria by Durack DT et al., (9), diagnosed IE by amalgamating the findings of echocardiography with microbiological and clinical data. The three major echocardiographic criteria for diagnosing IE include: 1) the presence of echogenic, opaque, mobile masses denoted as vegetations on the native or prosthetic valve or myocardium, 2) valvular or myocardial abscesses, 3) any breakdown of sutures leading to detachment of the prosthetic valve (10). The definitive diagnosis of IE can be made by the presence of either two major criteria with one minor criterion or the presence of one major criterion with three minor criteria.
The index patient met three of Duke’s major criteria which include the echocardiographic evidence of valvular vegetations, repeated positive blood cultures and new valvular regurgitations, and one minor criterion of high-grade fever above 38ºC (11). Out of 23 known cases of Achromobacter xylosoxidans endocarditis, only eight cases of prosthetic valve endocarditis are known in literature as described in (Table/Fig 3). The presence of an abnormal heart valve was observed in 65% of cases, which acts as a predisposing condition for IE (12),(13),(14),(15),(16),(17),(18),(19).
The age of the patient in present study was 47 years while the mean age of the patients who developed Achromobacter xylosoxidans prosthetic valve endocarditis was around 57.12 years, with equal prevalence among both the genders (12),(13),(14),(15),(16),(17),(18),(19). The vegetations of Achromobacter xylosidans endocarditis were commonly isolated from the prosthetic aortic valve in the studies by Tokuyasu H et al., (12), Ahmad MS et al., (14), Sawant AC et al (16), Van Hal S et al., (17), Lofgren RP et al., (13), and Olson DA and Hoeprich PD (18). Thus, prosthetic aortic valve endocarditis was observed in 66.67% (6/9) cases, which includes present case of prosthetic aortic valve endocarditis (12),(13),(14),(15),(16),(17),(18),(19).
In most of the cases discussed in the literature, IE caused by Achromobacter species was susceptible to beta-lactam antibiotics and beta-lactamase inhibitors, carbapenems, and trimethoprim/ sulphamethoxazole (TMP/SMX) (20), which was in agreement with present study were the patient was started on piperacillin-tazobactam, to which the isolate was sensitive by antibiotic susceptibility testing.
The mortality was more among the patients of Achromobacter species endocarditis who were treated with antibiotics only, in comparison to those managed with valve replacement surgery and antibiotics (12). The mortality among cases with prosthetic valve endocarditis who underwent antibiotic treatment only without valve replacement surgery was about 55.55% (5/9), including index patient in this case (12),(13),(14),(15),(16),(17),(18),(19). Thus valve replacement surgery although deemed important, index patient in this case was unable to survive due to underlying co-morbidities like new regurgitation on all valves and chronic kidney disease needing haemodialysis.
The management and diagnosis of Achromobacter species endocarditis are difficult due to the rare nature and atypical presentation of the disease with immunocompromised conditions and co-morbidities that render the patient susceptible to infections by rarely pathogenic microorganisms. Valve replacement surgery and appropriate antibiotic therapy are the mainstays of treating these cases as complete knowledge of management needs the reference of more rare cases and their treatment strategies to form an effective protocol of treatment.
Authors are indebted for the images of 2-D echocardiography provided to us by Dr. Roopali Khanna, Associate Professor, Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
DOI: 10.7860/JCDR/2022/58337.16952
Date of Submission: Jun 16, 2022
Date of Peer Review: Jul 11, 2022
Date of Acceptance: Aug 18, 2022
Date of Publishing: Sep 01, 2022
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. No
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jun 20, 2022
• Manual Googling: Aug 08, 2022
• iThenticate Software: Aug 26, 2022 (5%)
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