Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018




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Prof. Somashekhar Nimbalkar
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National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
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On Sep 2018




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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Lucknow
On Sep 2018




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On Aug 2018




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Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
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Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


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.
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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

Important Notice

Original article / research
Year : 2009 | Month : June | Volume : 3 | Issue : 3 | Page : 1557 - 1561 Full Version

Use Of Antibiotics For Respiratory Illnesses In Rural India


Published: June 1, 2009 | DOI: https://doi.org/10.7860/JCDR/2009/.511
SHARMA R *, CHOPRA V S **, KOUR G ***.

*(MD,DMCH) Clinical Pharmacologist ,***(MD)Pediatrician-Accidental Hospital, Vijay Pur, J&K Health Services.**Professor& head Postgraduate Deptt. of Pharmacology and Therapeutics, Govt. Medical College Jammu.(India)

Correspondence Address :
Dr Rashmi Sharma MD,DMCH,
216-A, Last-Morh Gandhi- Nagar,
Jammu, Tawi. Pin: 180004.J&K (INDIA)
E-mail:rashmichams@yahoo.com

Abstract

The increase in antibiotic resistance is one of the preventable threats being faced in the 20th century. Unnecessary antibiotic prescribing remains common not only in the developing countries, but also in the developed countries like USA and Britain. The present study was conducted to study the antibiotic prescribing pattern in paediatric patients with respiratory and ear infections in rural India.
Materials and Methods: The present prospective study was conducted in a rural health center (RHC) situated about 30 kilometers away from a tertiary care center. 2561 new (first encounter) prescriptions were studied.
Results: Out of the 2561 prescriptions, upper respiratory track infection (URTI), lower respiratory track infection (LRTI), asthma and acute otitis-media (AOM) were the diagnoses made in 29.28%, 5.46%, 5.85%, and 0.97% of the prescriptions, respectively. Cephalosporins were the most frequently prescribed antibiotics in all the age groups of patients. Azithromycin/ erythromycin/roxithromycin were the next most commonly prescribed antibiotics. All patients with URTI, LRTI, asthma and AOM, except 11.11% and 7.50% patients in the age groups of 6-10 years and 11-18 years respectively, received no antibiotic for URTI and 12% patients of AOM received no antibiotic.
Conclusion: Broad spectrum antibiotics are frequently used for viral respiratory illnesses which are generally self limiting, further adding to the threat of antibiotic resistance. There is a need to appoint clinical pharmacologists at various levels in a health setup to supervise and evaluate the prescriptions of doctors and to provide them feedback to improve their prescribing skills.

Keywords

Antibiotics, viral respiratory illness, rural pediatric patients.

Introduction
The inappropriate and economically inefficient use of medication in terms of poly pharmacy, use of drugs not related to the diagnosis, poor patient’s compliance, overuse and misuse of antibiotics and use of unnecessary expensive drugs has been commonly observed in the health care system throughout the world, especially in the developing countries (1). Unnecessary antibiotic prescribing remains common not only in developing countries, but also in developed countries like USA and Britain (2). Children represent an important target group for efforts aimed at reducing unnecessary antibiotic use, as they receive a significant proportion of the antibiotics prescribed each year (3) . The major factors responsible for high antibiotic use are the lack of knowledge about the use of antibiotics and the demand of patients (4). The present study was conducted to study the antibiotic prescribing pattern in paediatric patients with respiratory and ear infections in rural India.

Material and Methods

The present prospective study was conducted in a rural health center (RHC) situated about 30 kilometers away from a tertiary care center. The RHC caters to a population of about 1.5 lacs. The present observational study was conducted over a period of six months. About 2600 prescriptions of paediatric patients (<18 years) attending the paediatric and general OPDs of the RHC were randomly collected after taking the informed consent of the parents or the guardian. All the prescriptions were returned back to the patients after noting down the study variables. Out of 2600 prescriptions, 39 follow-up prescriptions were excluded and only 2561 new (first encounter) prescriptions were included. The study variables were the age of the child, diagnosis, the nature of the antibiotics prescribed and oral or injectable antibiotics prescribed.

Results

Out of 2561 prescriptions, upper respiratory track infection (URTI), lower respiratory track infection (LRTI), asthma and acute otitis media (AOM) were the diagnoses made in 29.28%, 5.46%, 5.85%, and 0.97% of the prescriptions, respectively.

Cephalosporins were the most frequently prescribed antibiotics in all the age groups of patients with URTI. However, cefadroxy was preferred most frequently (42.85%) in children under one year of age and cefixime (31.25%- 48.63%) in children with ages between 1 to 18 years. Azithromycin was prescribed in 21.87% of the children with ages between 11 to 18 years, as against 5.58% of children with ages between 1-5 years and in non in infants and children with ages between 6-10 years. All patients with URTI in age group between 0 to 5 years received antibiotics. However, 11.11% and 7.50% patients in the age groups of 6-10 years and 11-18 years received no antibiotics for URTI (Table/Fig 1), (Table/Fig 2).

Cefixime was the most frequently prescribed drug (30-40%) in all the age groups with LRTI. Azithromycin/ erythromycin/roxithromycin were the next most commonly prescribed antibiotics in older children (6-18 years of age) with LRTI. Injectible ceftriaxone was prescribed in 6% of the patients with LRTI, in the age group of 1-5 years.

In asthmatic patients, cefixime was the most frequently prescribed drug in 48.66% cases, fallowed by cefadroxy (16.66%), amoxicillin (13.33%) and Azithromycin (13.33%) cases. In AOM patients, cefixime was the most frequently prescribed drug in 28% of the cases, followed by amoxicillin (20% cases), amoxicillin-clavulenic acid (16% cases) and Azithromycin (16% cases), respectively.


Discussion

The increase in antibiotic resistance is one of the preventable threats faced in the 20th century. Much antibiotic prescription is of little value and a decreased prescription rate may lead to a low rate of resistance to them. On the other hand, lower antibiotic prescription seems to be theoretically associated with an increase in the complications of infections. However, in an analysis from England, it was found that a sustained decrease in antibiotic prescription rates in the recent past (1996-2002) was associated with a smaller corresponding increase in the admission rate for RTI (5).

In the present study, no antibiotic was prescribed for URTI and ASOM (which are mostly viral in nature) in 2.93% and 12% cases, respectively.

In a study from Dutch, an increased disease based prescription rate for antibiotics with more prescription of non-recommended broad spectrum antibiotics for ASOM, URTI and LRTI, was observed in 2001 than in 1987 (6).

In a cross sectional study from South India, 79.9% of children with ARI (Acute respiratory infection) and ADD (Acute watery diarrhea) were prescribed antibiotics. Penicillins (43.9%) were the commonest antibiotics prescribed (7).

In a study on 366 licensed paediatricians and family physicians in Georgia, 86% were found to prescribe antibiotics for bronchitis, regardless of the duration of cough and 42% prescribed antibiotics for common cold (8).However, 97% physicians agreed that overuse of antibiotics is a major factor contributing to the development of antibiotic resistance (8). In a study from USA, 44%, 46% and 75% children younger than 18 years of age, with common colds, URIs and bronchitis received antibiotics respectively (3). However, antibiotics were prescribed more often for children aged 5 to 11 years than for younger children (3). In another survey on the parent’s view regarding antibiotic use, 80% of parents were found to have given their child an antibiotic at home before consulting a physician and they believed that antibiotics were always or sometimes required for ear infections (93%), throat infections (83%), colds (32%), cough (58%), and fever (58%) (9). About 30% of paediatricians said that they agreed to the parent’s requests often or most of the time regarding the antibiotic prescription to their child (9).

Population-based data from British Columbia (from 1996 to 2003) revealed the increased use of macrolides and use of a large proportion of antibiotics in children for upper respiratory tract infections and bronchitis, indications where there is a high likelihood that the aetiology is viral rather than bacterial (10). It also showed that the use of erythromycin decreased by 72%, while the use of clarithromycin increased by almost 3-fold and the use of Azithromycin increased 81-fold in 2003 as compared to 2003 (10).

The patient’s lack of knowledge and past experience of receiving antibiotics for respiratory tract infections make them to believe that antibiotics are effective for viral respiratory illnesses which were generally self limiting. Parents often request doctors to prescribe antibiotics for viral conditions to their children and doctors mostly comply to their requests. There is need to convince doctors that a patient's satisfaction is based more on communication than on prescription. Moreover, economic factors contributing to over prescription of antibiotics in the form of incentives and gifts by pharmaceutical companies to the prescribers, is another factor which needs to be addressed. Hence, multifaceted interventions in the form of a public relations campaign with simple messages, clinic based patient education, and community outreach activities, are needed to reduce the unnecessary use of antibiotics. Moreover, physicians should be trained in rational prescribing skills by imparting them rational therapeutic guidelines and refresher training. Evidence-based reviews and guidelines recommend lesser use of antibiotics for acute respiratory infections, not only because the antibiotics are ineffective, but because their widespread use is thought to contribute to the development of antibiotic resistance. Some of the strategies recommended are :- reduce or do not prescribe antibiotics for bronchitis if pneumonia is not a concern, prescribe antibiotics only if symptoms do not improve after 48 hours, do not prescribe antibiotics for simple AOM or myringitis, do not prescribe broad spectrum antibiotics like azithromycin, use respiratory quinolones only in community acquired pneumonias or pneumonias in high risk patients (asthma, renal ,hepatic and cardiac failure, cancer and chronic obstructive air way disease) (11).

The economic rationale and the symbiotic relations that exist between doctors, medical-representatives, medicine wholesalers and retailers, need to be more closely scrutinized by those advocating rational drug use(12). There is a need to interrupt the viscous circle of supply and demand between physicians and the pharmaceutical industry by enforcing laws and appointing clinical pharmacologists at various levels in a health setup to supervise and evaluate the prescriptions of doctors and to provide them feedback to improve their prescribing skills.


References

1.
. Award AI, Himad HA. Drug use practices in the teaching hospitals of Khartoum State, Sudan. Eur J Clin Pharmacol 2006; 62:1087-93.
2.
. Belongia E A, Schwartz B. Strategies for promoting judicious use of antibiotics by doctors and patients. Br Med J 1998; 317:668-71.
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. Nyquist AC, Gonzales R, Steiner JF, Sande MA. Antibiotic prescribing for children with colds, upper respiratory tract infections, and bronchitis. JAMA 1998 ; 279(11):875-7.
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. Abdelmoneim IA, EI Tayeb IB, Omer ZB. Investgation of drug use in health centers in Khartoum State. Sudan. Med J 1999; 37:21-6.
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. Majeed A, Williams S, Jarman B, Aylin P. Prescribing of antibiotics and admissions for respiratory trat infections in England. Br Med J 2004; 329:879.
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. Otters HB, vander Wouden JC, Schellevis FG, van Suijlekom-Smit LW, Koe BW. Trends in prescribing antibiotics for children in Dutch general practice.J Antimicrob Chemother 2004; 53: 361-6.
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. Bharathiraja R, Sridharan S, Chelliah LR, Suresh S, Senguttuvan M. Indian J Pediatr 2005 ; 72(10):877-9.
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. Watson RL, Dowell SF, Jayaraman M, Keyserling H, Kolczak M, Schwartz B. Antimicrobial use for pediatric upper respiratory infections: reported practice, actual practice, and parent beliefs. Pediatrics 1999; 104(6):1384-8.
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. Palmer DA, Bauchner H. Parents' and physicians' views on antibiotics. Pediatrics. 1997 Jun; 99(6):E6.
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. Marra F, Patrick DM, Chong M, Bowie WR. Antibiotic use among children in British Columbia, Canada.J Antimicrobial Chemothe 2006 58(4):830-39.
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. Worrall G, Young B, Knight V. Inappropriate use of antibiotics for acute respiratory tract infections in a rural emergency department.CJRM 2005;10(2):86-8.
12.
. Sharma R, Verma U, Sharma CL, Kapoor B. Self-medication among urban population of Jammu city.Ind J Pharmacol 2005;37:40-3

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