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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
Invasive Aspergillosis and Candidiasis in a Patient with Supraglottic Carcinoma undergoing Chemoradiotherapy: A Case Report
Correspondence Address :
Dr. Jomon Raphael Chalissery,
Professor and Head, Department of Radiation Oncology, Amala Institute of Medical Sciences, Thrissur-680555, Kerala, India.
E-mail: joeraphael@gmail.com
The incidence of Invasive Aspergillosis (IA) is increasing. Early diagnosis and treatment are very important to improve patient survival, especially in immunocompromised patients. The diagnosis of IA is challenging as clinical indicators are limited, and early microbiological confirmation of the infection is infrequent. Here, the authors present the case of a 43-year-old male who was undergoing radiotherapy along with concurrent chemotherapy for carcinoma supraglottis. He developed Invasive Pulmonary Aspergillosis (IPA) along with candidiasis within two weeks of therapy. Voriconazole remains the recommended therapy for patients with IA, which also acts against fluconazole-resistant Candida species.
Candida, Radiotherapy, Voriconazole
A 43-year-old, male patient, was referred to the Radiation Oncology department with a persistent sensation of a foreign object in the right-side of his throat and painful swallowing for a period of six months. Additionally, he reported a change in his voice for the last month, along with experiencing earache on the right-side. No co-morbidities or risk factors were noted. On examination, no palpable neck or supraclavicular nodes were present. A 90-degree rigidscopy showed a well-defined soft tissue lesion (25×11.5×21.3 mm) in the right lateral hypopharynx protruding into the lumen, likely from the pyriform fossa, suggestive of neoplastic aetiology. A punch biopsy from the supraglottic growth showed well-differentiated squamous cell carcinoma (Table/Fig 1). He was diagnosed with Carcinoma supraglottis, stage T2N2bM0. Radical radiotherapy was planned with concurrent chemotherapy weekly using injection cisplatin. He received radiation treatment using Intensity Modulated Radiation Therapy (IMRT) technique in the head and neck region. The dose and fractionation were 70Gy/35 fractions with concurrent chemotherapy with injection cisplatin 40 mg/m2.
After two weeks of radiation therapy and two cycles of concurrent chemotherapy, he developed a sudden onset of fever, generalised tiredness, dyspnoea, and loose stools. He was admitted to the hospital, and routine blood investigations were performed, revealing severe neutropenia. The laboratory data were as follows: white cell count 0.11×103/μL with 18.2% neutrophils and 81.8% lymphocytes, haemoglobin 8.7 g/dL, haematocrit 24.5%, and platelets 50,000/μL (Table/Fig 2). Tests for dengue serology, H1N1, and malarial parasites were negative. He was managed conservatively with intravenous growth factors, fluids, and was started on antibiotic Piperacillin-Tazobactam 4.5 g intravenous every eight hours and fluconazole 150 mg once daily. Stool and blood cultures were sent, and he was shifted to the ICU for better care. The culture reports were negative, but his fever persisted. The antibiotic was changed to Injection Meropenem 1.5 g twice daily, and Tab Voriconazole 200 mg once daily was started. A chest X-ray was taken, which showed patches in the lung (Table/Fig 3). A High-Resolution Contrast Tomographic (HRCT) scan of the chest revealed signs of IA (Table/Fig 4). Bronchoscopy was performed, and Bronchoalveolar Lavage (BAL) was sent for culture, and a Galactomannan (GM) test was also done. The GM test (1) by lateral flow assay showed a value of 10.22, which was positive (an index value of ≥0.50 is positive and <0.5 is negative). His BAL and sputum culture showed Candida species growth (Table/Fig 5). VITEK identification and sensitivity testing were performed, which identified the species as Candida glabrata, which was resistant to fluconazole. The strain was sensitive to Voriconazole with a very low minimum inhibitory concentration value (0.12). Voriconazole 200 mg twice daily was continued, and the patient improved. His serum GM was checked after seven days, and it was 1.32. The laboratory data were as follows: white cell count 24.4×103/μL with 87.5% neutrophils and 4% lymphocytes, haemoglobin 8.5 g/dL, haematocrit 25.1%, and platelets 100,000/μL (Table/Fig 2). He was shifted from the ICU on the 18th day and was advised best supportive care.
The frequency of IA infections is increasing due to multiple factors. This rise in occurrences can be linked to a notable surge in patients receiving immunosuppressive therapy, along with their enhanced recovery rates from once-deadly bacterial infections (2). Patients with solid tumours are believed to have a low risk for IA, as per the study by Pagano L et al., (3). The patient presented in this report, who was receiving cisplatin chemotherapy along with radiation, was at a low-risk of developing IPA. He received standard doses of fluconazole against Candida, which is recommended for patients with neutropenia who are on chemoradiotherapy. Even with fluconazole prophylaxis, the patient developed candidiasis along with IA. The Candida species isolated was C. glabrata, which shows acquired resistance to fluconazole. Previously, mixed fungal infections have been documented; however, Candida albicans, the recognised pathogenic species, was the predominant occurrence (4).
To achieve favourable clinical outcomes in these patients, it is crucial to begin effective systemic antifungal treatment promptly. However, diagnosing IA can be challenging, as clinical indicators are limited, and early microbiological confirmation of the infection is infrequent. Obtaining a definitive diagnosis of the condition requires a tissue biopsy that allows direct visualisation of the branching septate hyphae through microscopic examination or recovery of the organism itself. However, obtaining tissue samples can be challenging in patients with thrombocytopenia or coagulation disorders, and it may not be feasible in individuals with high oxygen requirements (5).
Due to the challenges in obtaining tissue samples and the varying success rates of traditional cultures, clinical diagnosis relies on pulmonary Computed Tomography (CT) scan results and non culture-based diagnostic methods, such as detecting GM or DNA in blood or BAL samples [6,7]. These techniques help healthcare providers identify and manage invasive Aspergillus infections early, leading to better treatment outcomes for this vulnerable patient population. One widely used approach involves detecting the presence of GM. GM is a type of polysaccharide found in the cell wall of Aspergillus fungi, and it is released when the fungus grows. However, the sensitivity of this testing method can vary and depends on the immune status of the host. It tends to have higher sensitivity in patients with haematologic malignancies compared to those with milder levels of immune suppression (8). Patients on antifungal therapy may experience falsely negative GM results. Historically, false-positive GM results have been observed in patients receiving certain antibiotics like piperacillin-tazobactam and amoxicillin-clavulanate. However, recent reports suggest no cross-reactions with piperacillin-tazobactam (9),(10). Of particular interest is the ability to detect GM in lavage samples that show no growth in cultures (11). In the present case, although the BAL sample was sent for culture, it only grew Candida.
Candida albicans was the most commonly isolated species from head and neck cancer patients undergoing chemoradiotherapy, but recently non-albicans Candida species, especially C. tropicalis and C. glabrata, have been increasingly reported in these patients (12). The increased incidence of invasive candidiasis with C. glabrata is linked to the extended use of broad-spectrum antibiotics and corticosteroids, intensive chemotherapy, and prior fluconazole prophylaxis for antifungal protection. C. glabrata strains exhibit acquired resistance to fluconazole (13),(14).
Patients at high-risk for aspergillosis who receive preemptive antifungal treatment, supported by laboratory and imaging results, can expect the most favourable outcomes. Voriconazole is considered the best systemic antifungal treatment, as it has demonstrated significant superiority over conventional amphotericin B. Consequently, it has notably improved survival rates in patients with this condition (15). The patient presented in the current report also responded well to voriconazole. Voriconazole has also shown a more favourable side-effect profile and better overall tolerability. When initial therapy is ineffective or not well tolerated, echinocandins like caspofungin are used as salvage therapy (7). Given the differing mechanisms of action of azoles, trienes, and echinocandins, combining these therapies could be a potential strategy for treating IPA (7). However, currently, voriconazole is considered the treatment of choice for IPA (7),(15).
The challenges associated with acquiring tissue samples and the inconsistent effectiveness of conventional microbiological cultures have prompted a shift towards alternative diagnostic approaches for invasive Aspergillus infections. The reliance on pulmonary CT scans and advanced non culture methods, such as the detection of GM in blood or BAL samples, has become pivotal in the clinical diagnosis of these infections. These techniques enable early identification and management of IA, leading to improved treatment outcomes. Voriconazole remains the recommended therapy for patients with IA. The reported case and broader evidence highlight the efficacy of voriconazole and its favourable side-effect profile, enhancing its overall tolerability.
Authors are grateful to the Department of Radiodiagnosis and to Dr. Geetha CG, Assistant Professor, Department of Pathology, Amala Institute of Medical Sciences, Thrissur, Kerala, India for the images.
DOI: 10.7860/JCDR/2023/67157.18759
Date of Submission: Aug 22, 2023
Date of Peer Review: Sep 18, 2023
Date of Acceptance: Oct 18, 2023
Date of Publishing: Dec 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: Aug 25, 2023
• Manual Googling: Oct 02, 2023
• iThenticate Software: Oct 16, 2023 (3%)
ETYMOLOGY: Author Origin
EMENDATIONS: 6
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