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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
Bilateral Bacterial Endogenous Endophthalmitis following Haemodialysis in a Diabetic Patient: A Case Report
Correspondence Address :
Rutu Rao,
75, Shubhangan Bunglows, Panchavati Area, Kalol, Gandhi Nagar-382721, Gujarat, India.
E-mail: ruturao1996@gmail.com
Endogenous endophthalmitis, a severe infection originating from the bloodstream, can lead to blindness and is particularly dangerous for immunocompromised patients, including those with diabetes, cancer, or undergoing chemotherapy. This condition differs from exogenous endophthalmitis, which arises from external sources such as postoperative complications or trauma. Hereby, the authors present a case report of a rare instance of bilateral bacterial endogenous endophthalmitis in a 45-year-old male with multiple systemic co-morbidities. The patient experienced vision loss and photophobia; further investigation revealed septicaemia linked to an in-situ haemodialysis catheter. Prompt treatment with intravenous antibiotics is crucial, and vitrectomy may also be considered. The present case is unique because, despite the infection originating in the bloodstream, the patient developed ocular symptoms first. A retrospective analysis revealed the primary source of the infection, highlighting the importance of a thorough examination.
Blood-borne, Enucleation, Exogenous, Vitrectomy
A 45-year-old male with a known history of diabetes mellitus, hypertension, stage 5 chronic kidney disease, and bronchial asthma presented to the Ophthalmology Outpatient Department (OPD) with complaints of vision loss and sensitivity to bright light in the right eye, as well as diminished vision in the left eye for the past 5-6 days. The patient was unable to walk on his own. He was on a regular cycle of haemodialysis (twice a week) with an in-situ catheter. On examination, his blood pressure was 160/90 mmHg. The Glasgow Coma Scale score was 13 out of 15 upon presentation. The patient appeared lethargic during the examination but was cooperative and oriented to time, place, and person.
The patient presented with an absence of light perception in the right eye and a visual acuity of 20/200 in the left eye. On torch light examination, proptosis was noted in the right eye (Table/Fig 1). A slit lamp examination revealed an exudative membrane in the anterior chamber of the right eye, covering the pupillary axis. Approximately 2 mm of hypopyon was noted inferiorly in the left eye. The pupillary reflex in the right eye was not appreciated due to the presence of the exudative membrane, while it was central, circular, and sluggishly reactive to light in the left eye. The fundus could not be visualised in the right eye, while vitritis was present in the left eye.
Based on the history, clinical signs, and symptoms, a provisional diagnosis of endogenous endophthalmitis was considered. To confirm the diagnosis, ocular ultrasonography was performed. The ultrasonography showed multiple hyperechoes and a vitreous membrane in the vitreous (Table/Fig 2). The patient’s general condition deteriorated further, necessitating admission to the intensive care unit. Laboratory investigations indicated an active infection, with a total blood count of 17,000/mm3.
Blood was sent for culture and sensitivity testing before starting any intravenous antibiotics, which indicated sensitivity to meropenem and voriconazole. The patient received an intravitreal injection of vancomycin (1 mg), voriconazole (50 μg), and ceftazidime (2.25 mg) in the left eye, and vancomycin (1 mg) in the right eye to prevent further damage on the same day. The patient was started on meropenem 500 mg twice daily, voriconazole 200 mg once daily, vancomycin 1 g once daily, and eye drops: dorzolamide twice daily, gatifloxacin plus prednisolone (Gati-P) six times a day, and homatropine twice a day.
The blood culture report was positive for methicillin-resistant Staphylococcus aureus, confirming the diagnosis of endogenous endophthalmitis. The hematogenous type was confirmed after receiving the positive culture report from the site of the in-situ haemodialysis catheter. Initially, after initiating treatment, the hypopyon in the left eye resolved. The intravitreal injection of vancomycin was repeated following the blood culture report. However, there was no visual improvement in the right eye, and vision in the left eye also deteriorated. Enucleation of the right eye was advised; however, the patient could not undergo the procedure due to systemic unfitness.
The patient was under observation for about 12 days, during which his condition deteriorated systematically, and panophthalmitis developed in the right eye despite treatment. Despite extensive efforts to manage the patient with available treatments, he could not be saved.
The present case involved a patient with complex systemic conditions who presented to the Ophthalmology OPD with ocular symptoms. Further evaluation traced the source of the infection, revealing endogenous endophthalmitis via a hematogenous route, originating from an in-situ haemodialysis catheter. This was confirmed by a positive culture report obtained from the site of the in-situ haemodialysis catheter.
The endogenous form of endophthalmitis is relatively rare, constituting only 2-8% of all endophthalmitis cases (1). Moreover, among those with endogenous endophthalmitis, around 12% experience the condition bilaterally, meaning both eyes are affected (2). However, there has been an increase in the number of cases of endogenous endophthalmitis as the population of chronically ill patients grows and the use of invasive procedures rises. This condition occurs when the posterior segment of the eye is involved in the presence of an infective source in the body. While it can affect both eyes, it mostly affects one eye, particularly the right eye, due to its direct blood flow from the heart to the right carotid artery (3). Individuals with immunodeficient conditions are at a higher risk of developing it, especially those with diabetes mellitus, where the growth of microorganisms is more pronounced due to the high availability of blood glucose (4). Symptoms of this condition include redness, photophobia (increased sensitivity to bright light), loss of vision, diminished vision, proptosis, and hypopyon. Investigations include blood culture, intraocular culture, and ocular ultrasonography. Treatment options include intravenous antibiotics (empiric broad-spectrum antibiotic therapy) and vitrectomy (4).
The organisms causing endogenous endophthalmitis are primarily either bacteria or fungi. The most frequently identified causative bacteria are Staphylococcus aureus and Streptococcus pneumoniae. In East Asia, however, Klebsiella pneumoniae is predominantly responsible. Among fungal organisms, Candida albicans is the most common yeast, while Aspergillus is the most common mould. Staphylococcus aureus is a versatile Gram-positive bacterium that can cause various clinical manifestations. Managing it can sometimes be challenging, especially as more cases of Methicillin-resistant Staphylococcus Aureus (MRSA) emerge (5),(6).
In a study conducted on 34 affected eyes in 27 patients, the mean age was found to be 63 years, with a range of 30 to 85 years (7). Risk factors for developing endogenous endophthalmitis include diabetes mellitus, long-term corticosteroid use, immunosuppression, a history of recent hospitalisation, ventilator-associated pneumonia, malignancies such as lymphoma and leukaemia, colon adenocarcinoma, urinary tract infections, dental infections, scleral perforation, vertebral osteomyelitis, liver abscess, asplenia, hypogammaglobulinemia, cardiac or renal transplantation, acquired immune deficiency syndrome, chronic alcoholism, intravenous catheters, and drug abuse (8),(9),(10),(11).
The incidence of endogenous endophthalmitis ranges from 2% to 8%, making it a rare pathology. Symptoms that may raise suspicion of endogenous endophthalmitis include pain, photophobia, diminished vision, and redness. Clinical signs include periorbital oedema, conjunctival congestion, chemosis, cells or flare in the anterior chamber, hypopyon, abnormal pupillary reactions, absence of the red reflex, vitreous haze, and the presence of exudates and membranes. To confirm the diagnosis, author relied on several diagnostic modalities: B-scan ultrasonography, which shows heterogeneous opacities and echoes in the vitreous cavity when the posterior segment is involved, and optical coherence tomography, which helps to identify the location of exudates within the retinal layers. An anterior chamber or vitreous tap can be performed to obtain a sample of 0.1-0.2 mL or 1-2 mL, which is then sent for culture and sensitivity testing. This helps identify the exact causative organism, allowing for specific management of the case (12).
A vigorous treatment approach is necessary, as this condition has a very poor prognosis even after treatment. Management includes systemic antibacterials, as well as topical and intravitreal agents. The standard doses of intravitreal antibacterial agents are as follows: vancomycin 1 mg/0.1 mL, ceftazidime 2.25 mg/0.1 mL, or amikacin 0.4 mg/0.1 mL (13). Surgical options include pars plana vitrectomy (14). Chronic kidney disease is one of the co-morbidities associated with the development of endogenous endophthalmitis. The pathogenesis is thought to be related to the in-situ haemodialysis catheter, which can be a primary source of infection (14). The prognosis depends on various factors, including the patient’s associated co-morbidities, overall condition at the time of presentation, extent of the pathology, and the causative organism.
The final diagnosis of endogenous endophthalmitis following haemodialysis was made when the patient presented to the Ophthalmology OPD with vague ocular complaints. Given the wide range of possible differential diagnosis based on the initial symptoms, a thorough assessment that considered the patient’s existing co-morbidities and a detailed examination were essential. This comprehensive approach led to the identification of both the diagnosis and the primary cause of the condition.
DOI: 10.7860/JCDR/2024/74172.20260
Date of Submission: Jul 15, 2024
Date of Peer Review: Aug 02, 2024
Date of Acceptance: Sep 21, 2024
Date of Publishing: Nov 01, 2024
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. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jul 16, 2024
• Manual Googling: Aug 14, 2024
• iThenticate Software: Sep 20, 2024 (7%)
ETYMOLOGY: Author Origin
EMENDATIONS: 7
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