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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
Utility of Umbilical Cord Blood Culture in the Diagnosis of Early Onset Sepsis: A Cross-sectional Study
Correspondence Address :
Dr. Sujit Mulay,
Rural Medical College, Loni, Ahmednagar-413736, Maharashtra, India.
E-mail: sujitmulay20@gmail.com
Introduction: Umbilical cord is the first source of blood from the neonate. The clinical signs associated with sepsis are frequently non specific and subtle in the neonates making the diagnosis of infection difficult. Umbilical cord blood does not involve pain infliction, avoids iatrogenic blood loss and procedural complications.
Aim: To evaluate the utility of Umbilical Cord Blood Culture (UCBC) in the diagnosis of Early Onset Sepsis (EOS).
Materials and Methods: The present study was a cross-sectional study carried out in neonatology unit of Department of Paediatrics, Rural Medical College, Loni, Maharashtra, India, for the period of mid-March 2021 to mid-September 2021. Neonates delivered in Rural Medical College to the mothers having the risk factors for EOS were included in this study. Informed consent was taken prior to start of study. Thus, 68 samples were collected and studied. UCBC was collected with all aseptic precautions immediately after the umbilical cord was cut after the birth of the baby, venous blood sample was collected within one hour of birth. The data was presented as count and percentages.
Results: Majority were female neonates 40 (58.8%). On analysing maternal risk factors it was seen 8.8% had previous low birth weight and 13.2% had Rh negative status. Analysis for presence of risk factors for sepsis majority 79.4% were multiple times examined per vaginally, followed by 36.8% had foul smelling liquor, 11.8% had febrile illness and 5.8% had birth asphyxia. On umbilical cord culture and sensitivity, most common microorganism identified was Staphylococcus aureus 8 (11.8%), followed by 8.8% Pseudomonas species. So, present study shows that 35.3% (24 cases) had positive culture reports using utility of UCBC in 68 patients.
Conclusion: Study concludes that umbilical cord blood sampling and culture can be used as a tool for diagnosing bacterial sepsis in neonates especially the high-risk neonates.
Antibiotics, Birth weight, Haematology, Neonatal septicaemia
Being an initial haematological source, umbilical cord blood can be a beneficial diagnostic examination for EOS in neonates, but it is not used commonly (1). Blood culture from the peripheral vein still remains as the gold standard for neonatal sepsis. However, due to inadequate sample volume, administration of antibiotics prior to sample collection and administration of intrapartum antibiotics, there is inconsistency in blood culture sensitivity (2). Organisms responsible for neonatal sepsis is important to identify for appropriate antibiotic selection and administration as duration of treatment depends on it (3),(4).
The clinical signs associated with sepsis are frequently non specific and subtle in the neonates making the diagnosis of infection difficult. Moreover, awaiting the clinical emergence of the sepsis before beginning treatment diminishes the chances of successful outcome. The procedure of withdrawing blood from peripheral vein is very painfull and it even requires skilled and trained healthcare personals. For proper culture, proper technique and time is required. Whereas, on other hand the withdrawal of umbilical cord blood is painless and less complicated.
It is seen that the UBCC is reliable and safe for evaluation of sepsis among the asymptomatic neonates. It can also be used for screening purpose of EOS among the high-risk group. UCBC shows around ~20-47% positivity in high-risk neonates (1),(2),(3),(4),(5). Present study was thus undertaken to evaluate the utility of UCBC in the diagnosis of EOS.
A cross-sectional study was carried out in neonatology unit of Department of Paediatrics, Rural Medical College, Loni, Maharashtra, India for the period of six months mid-March 2021 to mid-September 2021. Neonates delivered in Pravara Rural Hospital to the mothers having the risk factors for EOS were included in this study. Institutional Ethical Committee (IEC) approval was taken Number (PIMS/DR/RMC/2021/462). Informed consent was taken from the parents before including the case in the study.
Inclusion criteria: All singleton neonates delivered in PRH with birth weight >1500 gm and >32 weeks those were at risk of developing EOS based of presence of two or more risk factor such as:
1. Preterm
2. Low birth weight
3. Premature or prolong rupture of membrane (>18 hours)
4. Prolong labour (>24 hours both stages) and difficult delivery with instrumentation
5. Febrile illness in the mother during or within two weeks of delivery
6. Meconium foul smelling and/or meconium stained liquor Amnii
7. Birth asphyxia
8. Urinary Tract Infection (UTI)
9. Foetal distress
10. Single unclean or more than three vaginal examination during labour.
Exclusion criteria: Babies with <1500 gm andbobbies born <32 weeks, babies with any congenital anomalies.
UCBC and processing: The umbilical cord was clamped at the placental side and the infant side. Thereafter the cord was cut and handed over to the nurse. The cord was wiped three times with 70% isopropyl alcohol using sterile technique. Using a sterile 22-gauge needle and syringe, approximately 2 mL of blood was drawn into the syringe from the umbilical vein or artery from placental end. Syringe was replaced with a new sterile needle and the top of culture bottle was wiped with alcohol. Then 2 mL of blood was injected in an aerobic blood culture bottle and sent to the microbiology laboratory. Sample was processed for five days and sample which was reported positive, detail antibiotic sensitivity was done. Thus, such 68 samples were collected and studied.
Statistical Analysis
The data was collected in Microsoft Excel sheet and results were presented as count and percentage.
Utility of UCBC in 68 patients were evaluated and majority patients were female children’s (58.8%) (Table/Fig 1). Female preponderance was more with female: male ratio of 1.4:1. Mean birth weight was 2276.83 grams. Majority 45.5% had birth weight <2000 grams (very low birth weight). Only 32.4% had normal birth weight i.e >2500 grams. On analysing maternal risk factors it was seen that previous neonatal death were 47.8%, 8.8% were previous low birth weight and 13.2% had Rh negative status. Laboratory investigation and risk factors for sepsis is shown in (Table/Fig 2), (Table/Fig 3). Only 10.3% neonates had positive CRP levels for sepsis. (Table/Fig 4) shows that on UCBC, 35.3% were culture positive and most common microorganism identified was Staphylococcus aureus 11.8%, followed by 8.8% Pseudomonas species and so on.
Present study showed female preponderance. It was seen that 58.8% were female child. Female: male ratio was 1.4:1. Study by Kalathia MB et al., (5) showed that F:M was 26:17, but in study by Ojha M et al., (6) males were more than females. M:F was 1:0.9. Jain P and Gosai M (7) showed that males were more M:F was 14:12.
Mean birth weight was 2276.83 grams. Majority 45.5% had birth weight <2000 grams. That means very low birth weight. Only 32.4% had normal birth weight I.e >2500 grams. Study by Kalathia MB et al., (5) showed that mean birth weight was 2.25 kgs, similar to present study. Study by Ojha M et al., (6) showed that, 51% neonates had a normal birth weight (>2.5 kg) whereas 33% neonates had a birth weight between 1.5 and 2.5 kg. 14 (14%) and 2% neonates had very low birth weight (<1.5 kg) and extremely low birth weight (<1 kg), respectively. Jain P and Gosai M (7) showed that among Peripheral Venous Blood Culture (PVBC) positive neonates 18 neonates had weight between 1-2 kgs, no neonate was below 1 kg but among UCBC group one neonate had weight less that 1 kg.
On analysing maternal risk factors it was seen that 8.8% had previous low birth weight and 13.2% had Rh negative status. Analysis for presence of risk factors for sepsis majority 79.4% were multiple times examined per vaginally, followed by 36.8% had foul smelling liquor, 11.8% had febrile illness and 5.8% had birth asphyxia. Study by Kalathia MB et al., (5) showed 24.44% high-risk factors. Study by Ojha M et al., (6) showed that 19% cases had foul smelling liquor. Jain P and Gosai M (7) showed respiratory distress in (28.6%) followed by 23.8% having abdominal distension while none had sclerema, bleeding and hypoglycaemia, Tyler CW jr and Albers WH (8) showed 9%, Polin JI et al., (4) showed 3%. A study by Rathi PP et al., (9), early-onset neonatal sepsis was present in 13% of the neonates and had occurrence of foul smelling. There are various studies since ages for UCBC such as Tyler CW jr and Albers WH (8), Polin JI et al., (4), Pryles CV et al., (10), Herson VC et al., (11), etc all of them collected the umbilical cord blood for diagnosis the sepsis.
On UCBC, most common microorganism identified was Staphylococcus aureus 11.8% and 8.8% Pseudomonas species. Only 10.3% neonates had positive CRP levels for sepsis. Previous data by Bhat YR et al., (12) on 2182 neonates showed 33.2% of the Pseudomonas which was the highly isolated organism, followed by Klebsiella (31.4%), Acinetobacter (14.4%), S. aureus (9.2%), E. coli (4.4%). In a study by Tallur SS et al., (13) Klebsiella and Pseudomonas found to be the most common organisms causing EONS. Even Chacko B and Sohi I (14) found majority of Pseudomonas (60%).
So, present study shows that 35.3% (24 cases) had positive culture reports Using UCBC in 68 patients. Study by Kalathia MB et al., (5) showed 24.44% positive rate on UCBC and Pseudomonas was most common organism found. Results were similar to present study. Study by Ojha M et al., (6) showed 32% had positive sepsis findings. Similar findings were seen in present study. Even Pryles CV et al., (10), Chacko B and Sohi I (14), and Fos NI et al., (15) showed 31%, 20.6%, and 28% positive rate respectively. Pais M et al., (16) also showed most common organism found as Pseudomonas 11.46%. Same results were seen by Meena R et al., (17) where, UCBC was positive in 21.2%. All culture positive neonates were subclinical cases, which suggest early diagnosis of sepsis and helps in further management.
Limitation(s)
The study sample size was small and patients history was not complete in some cases.
Study concludes that UCBC can be used as a tool for diagnosing bacterial sepsis in neonates especially the high-risk neonates. One more risk factor exceptionally identified was the multiple per vaginal examinations. Doctors should take atmost care and follow aseptic conditions so as to decrease the further complications.
DOI: 10.7860/JCDR/2022/56937.16829
Date of Submission: Apr 06, 2022
Date of Peer Review: May 31, 2022
Date of Acceptance: Jul 06, 2022
Date of Publishing: Sep 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:
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• iThenticate Software: Jul 05, 2022 (25%)
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