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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
Case report
Full Version
Rare Presentation of Pleural Empyema due to Non Typhoidal Salmonella-A Case Report
Correspondence Address :
Dr. M Mohamadiya Rizwana,
Off Avinashi Road, Peelamedu, Coimbatore, Tamil Nadu, India.
E-mail: mrizwana123@gmail.com
Non typhoidal Salmonella usually causes bacteraemia, enterocolitis, and endovascular infection, but pleuro-pulmonary illness is uncommon, mainly observed in patients with a background of malignancy, underlying pulmonary diseases. Localisation of the infection has been witnessed at various sites following a bacteraemia, but case reports on pulmonary focus are minimal. Here, we report a case of a 36 year old male patient who presented to Emergency Department with an underlying Non-Hodgkin’s Lymphoma along with a left sided pleural effusion. Pleural fluid tapping was done and the sample was sent for microbiological analysis. The pleural fluid culture along with serotyping confirmed the organism as Salmonella enterica serovar Typhimurium. The patient was discharged after parenteral Ceftriaxone therapy and symptom resolution. The present case adds to the growing body of evidence of rare presentation of non typhoidal Salmonella, as a probable aetiological agent of infection in exudative pleural effusions.
Gram-negative bacteria, Immunocompromised, Lymphoma, Pleural effusion, Pulmonary illness, Serotyping, Underlying diseases
A 36-year-old male patient, presented to the Emergency Department with complains of breathing difficulty. He was a known case of low-grade B-cell Non-Hodgkin’s Lymphoma Follicular (NHLF) type with Follicular Lymphoma International Prognostic Index (FLIPI) score of 3 (based on the clinico-biological features) indicating the patient falls under high-risk category. The patient was due for chemotherapy for his underlying condition but deferred due to the presenting complaints. Following initial evaluation, he was admitted and therapeutic thoraco-centesis was done and around 1.5 L chylous effusion was removed and sent for culture and sensitivity. The analysis showed a transudative picture with no bacterial growth on culture following which intrapleural streptokinase was initiated. The patient showed marked clinical improvement and was discharged. Following two months of this episode, he presented to Emergency Department, again with complaints of left-side chest pain, worsening dyspnoea and orthopnoea for two days.
Physical examination revealed afebrile state with an oxygen saturation (SpO2) of 88% initially, respiratory rate of 20 breaths/min and tachycardia (irregular) with normal blood pressure (120/70 mmHg). Following this, patient was started on supplemental oxygen and was found to be comfortable. Cardiovascular examination was normal. Respiratory system examination revealed dullness to percussion in the left middle to lower zones, with reduced breath sounds noted in the same area. Initial pathology revealed white blood cell count of 12×109 per litre with 74% neutrophils and 14.6% lymphocytes (20-40% lymphocytes). C-Reactive Protein (CRP) was elevated at 130 mg/L. Chest X-ray revealed left-sided pleural effusion (Table/Fig 1).
The patient was transferred to the ward and left Inter-Costal Drainage (ICD) was done. And around 1500 mL of chylous fluid was drained. The Triglyceride (TGL) level was observed to be 524 mg/dL.
The Triglyceride (TGL) level was observed to be 524 mg/dL. Pleural fluid was also sent for GeneXpert to rule out tuberculosis and conventional microbiological analysis. The pleural fluid was cultured on blood agar and MacConkey agar. Non haemolytic grey moist colonies and non lactose fermenting colonies were observed in blood and MacConkey agar, respectively after 24 hours of incubation at 37°C. Following this, the manual biochemical tests were done, which included indole (negative), Triple Sugar Iron (TSI) slant (alkali/acid), Mannitol motility (motile), citrate (positive), urease (negative). The identification was confirmed by Vitek 2 GN ID card (21341). Bacterial serotyping was done using antisera (Denka Seiken, Japan) which confirmed the strain as Typhimurium (H-i). The serotyping was further verified by sending the isolate to Central Research Institute (CRI), Kasauli whose result was in concordance with the laboratory result (Salmonella typhimurium).
The isolate was finally confirmed as Salmonella enterica serovar Typhimurium. Thus, the patient was diagnosed as a case of pleural empyema caused by Salmonella enterica serovar Typhimurium (Salmonella typhimurium). The isolate was sensitive to ceftriaxone and azithromycin but resistant to quinolones by manual disc diffusion performed in accordance to Clinical and Laboratory Standards Institute (CLSI) 2022. (Perfloxacin was reported resistant) (1). The patient was started on i.v. ceftriaxone therapy for one week. Simultaneously, he was reviewed for chemotherapy, and was deferred due to the ongoing infection. The patient showed a marked clinical response to i.v. therapy, which was followed with two week course of oral cefixime. There was a marked improvement in inflammatory markers. The Inter-Costal Drainage (ICD) was removed when fluid was less than 100 mL. Additionally analgesics, antiemetics and vitamin supplements were given. He was discharged with stable condition and advised follow-up in four weeks. In the review, the patient was stable and referred to medical oncology for initiation of chemotherapy for his underlying condition.
The most common symptom of Salmonella infection is acute enterocolitis. Any Salmonella serotype can produce Salmonella bacteraemia following a primary focus. In England and Wales, Threlfall EJ et al., found that infections with Salmonella enteritidis and Salmonella typhimurium resulted in most of the bacteraemias, but infections with S.choleraesuis, S.dublin, and S.virchow resulted in the highest rate of septicaemia (2). Salmonella infections, on the other hand, can cause extraintestinal symptoms, as well as, localised infections such as septic arthritis, osteomyelitis, vascular infection, endocarditis, urinary tract infection, and splenic abscess. With non typhoidal gastroenteritis, bacteraemia can develop in upto 8% of patients, and localised infection can happen primarily in newborns, the elderly and immunocompromised patients. In less than 1% of patients, Salmonella may be observed as a chronic carrier. There are very few cases of pleural empyema caused by Salmonella enteritidis (3). A review of case reports of Salmonella associated with pulmonary infections, has been listed in the (Table/Fig 2) (4),(5),(6),(7),(8),(9),(10),(11),(12),(13),(14).
Those with co-morbid conditions such as diabetes mellitus, sickle cell anaemia, malignancies such as lung cancer, leukaemia, and lymphoma, as well as, patients undergoing corticosteroid therapy, are most commonly affected by Salmonella empyema. The present case discussed here, on the contrary was young, but a known case of B-cell Non-Hodgkin’s lymphoma. Salmonella syndrome is common in people with cellular immunodeficiency, such as Acquired Immuno-deficiency Syndrome (AIDS), because Salmonella is an intracellular pathogen. The treatment of these patients is typically challenging, and they frequently become victims of repeated infections (3),(15). Interesting feature accounting in the present case is that, the patient had a similar admission nearly seven weeks back and the thoraco-centesis revealed a transudative picture, with negative bacterial culture analysis of pleural fluid. Leukocytosis is a common symptom of non typhoidal empyema (16). Immunosuppression in the background of malignancy and chemotherapy could be related to absence of leukocytosis. The raised CRP would have been a better way to track the immune response (17),(18). In individuals with positive blood cultures for Salmonella, the possibility of localised infections like empyema should be considered with non typhoidal strains despite its rare occurrence (3).
Salmonella species is thought to lie dormant in the Reticuloendothelial System (RES), where it could be reactivated and spread haematogenously. Due to the low bacterial burden in Salmonella bacteraemia, blood cultures are frequently negative. With the progression of the illness, the sensitivity of blood culture detection also decreases (17),(19). Patients with Hodgkin’s disease have consistent cellular immune abnormalities that they endure during active presentation or in remission. Patients’ depressed cell-mediated immunity has an impact on humoral immunity also. These elements together make the patient more vulnerable to opportunistic infections and make them susceptible to infections due to intracellular organisms as Salmonella (20).
Salmonella bacteraemia or localised infection can be treated with a variety of antimicrobial agents as per sensitivity report. Ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, and third-generation cephalosporins have demonstrated to have an acceptable action. Infection of the pleuro-pulmonary area with Salmonella associated with a high death rate. This, however, could be due to other contributing features (15). Fortunately, patient in the present study, was prescribed parenteral Ceftriaxone, based on the antibiotic sensitivity report, and he showed a marked clinical response. In the follow-up, the symptoms fully resolved that, he was referred for further chemotherapy, to treat his underlying disease.
The present case report demonstrated the importance of non typhoidal Salmonella infection in immunocompromised patients particularly cancer patients. In many cases of localised Salmonella infection, the initial source of infection cannot be identified, especially when there is a lack of gastrointestinal symptoms, absence of raised leucocytes and negative stool or blood cultures to confirm the source. But, with the initiation of appropriate antibiotic therapy, the fatality rate can be minimised. The authors believe that, more research is necessary to better in understanding the pathogenicity of the bacterium in these patients.
DOI: 10.7860/JCDR/2023/59737.17425
Date of Submission: Aug 26, 2022
Date of Peer Review: Sep 29, 2022
Date of Acceptance: Nov 10, 2022
Date of Publishing: Jan 01, 2023
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. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Sep 03, 2022
• Manual Googling: Oct 24, 2022
• iThenticate Software: Nov 07, 2022 (6%)
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