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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 Series
Full Version
Respiratory Syncytial Virus-related Lower Respiratory Tract Infections in Neonatal and Post-neonatal Babies: A Series of Four Cases
Correspondence Address :
Darshan Rajatadri Rangaswamy,
NH-13, Purle, Shimoga-577201, Karnataka, India.
E-mail: rajatadri93@gmail.com
Respiratory Syncytial Virus (RSV) is a highly contagious seasonal virus that is the leading cause of acute Lower Respiratory Tract Infections (LRTI) in the paediatric age group and is one of the leading causes of death in children under five in developing countries. There is evidence that severe RSV infection and hospitalisation in early life increase the risk of recurrent wheezing, childhood asthma, and allergic sensitisation. Even though RSV being a major global health concern, very few papers concentrate on the neonatal period in India. The present case series presents four cases (three females and one male baby) highlighting the impact of RSV in neonatal and post-neonatal infants in India. The cases highlight the diversity of presentation; one infant required prolonged High-flow Nasal Cannula (HFNC) support, while two needed just symptomatic care. The importance of Polymerase Chain Reaction (PCR) in resource-constrained situations is highlighted as diagnostic issues are examined. Treatment focuses on supportive care; oxygen and respiratory support are provided in more severe cases. The present study emphasises the need for early detection and preventative measures, such as using novel treatments like nirsevimab. The present case series advocates for focused therapies and additional research in the Indian paediatric environment, adding insightful perspectives to the expanding body of knowledge on RSV.
High flow nasal cannula, Neonatal intensive care unit, Newborn, Pneumonia
The Respiratory Syncytial Virus (RSV) is the most common viral pathogen identified in children with acute LRTI (1). In 2020, it was estimated that the disease burden associated with RSV among children under five years in low and lower-middle-income countries was 20.8 million cases, 1.8 million hospital admissions, and 40,000 deaths (2). Despite the significant burden, severity, and complications associated with RSV infections, there is a lack of reports in the immediate post-neonatal period in India. Here, four cases of RSV infection among infants in their neonatal and immediate post-neonatal period have been reported.
Case 1
A 19-day-old female neonate with no significant antenatal history and a history of Neonatal Intensive Care Unit (NICU) admission due to low birth weight (birth weight of 1900 g) was admitted to the NICU with a history of fever, cough, and a runny nose for the past six days, and rapid breathing for the past one day. There was a history of similar complaints in an elder sibling. The baby had a room air Peripheral Saturation of Oxygen (SPO2) of 88% and Downe’s score of 5; hence, O2 by prongs was started, but as the child’s condition deteriorated on the third day of admission, respiratory support was escalated to High-flow Nasal Canula (HFNC) with a maximum Fraction of inspired oxygen (Fio2) of 55%. Considering pneumonia, intravenous (i.v.) antibiotics were started. The chest X-ray taken on the first day of admission showed bilateral perihilar infiltrates (Table/Fig 1). The X-ray on the third day of admission revealed a worsening picture with bilateral confluent reticulonodular opacities (Table/Fig 2). The sepsis screen was negative, and considering the clinicoradiological features of viral aetiology, a throat swab Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) was done using the RealStar® RSV RT-PCR Kit 3.0, which showed RSV type B positivity. Hence, i.v. antibiotics were stopped. The baby required eight days of respiratory support with HFNC, along with supportive management. After ten days, the baby was discharged with a good outcome and was doing well on weekly follow-up for a month.
Case 2
A 21-day-old female baby, born as a late preterm at 2.3 kg with no significant perinatal history, was brought in with complaints of a runny nose for the previous week and a cough for two days, which was associated with noisy and hurried breathing. The baby also had a fever for one day just before admission. The baby was admitted with respiratory distress in the form of chest retractions, an SpO2 of 90% at room air, and a Downe’s score of 5. The infant was brought to the NICU with a tentative diagnosis of pneumonia and began on blended oxygen at an Fio2 of 40%. The sepsis screen performed as part of the late-onset sepsis protocol was positive. Thus, the neonate was started on i.v. antibiotics. The clinical examination and X-ray indicated viral aetiology (Table/Fig 3); therefore, a throat swab for RSV and influenza was found positive for RSV-B, after which the antibiotics were discontinued since the blood culture was sterile. Oxygen was weaned down by fourth day. Throughout the hospitalisation, the baby remained afebrile. She was sent home in good condition after six days and is doing well on weekly follow-ups for a month.
Case 3
A 29-day-old male baby, born at term weighing 3.9 kg, with transient tachypnoea of the newborn at birth, was brought in with complaints of breathing difficulty during feeds. The baby had hurried 2and noisy breathing for 20 days, and chest indrawing was noted for the last four days. At admission, he had chest retractions and tachypnoea, but his SpO2 was maintained at room air. Bilateral wheezing on auscultation was noted, and the Downe’s score was 4. The baby, however, did not have any other features of sepsis, and his cardiac examination was unremarkable, so he was managed symptomatically. The clinical examination indicated viral aetiology; therefore, a throat swab for RSV and influenza was performed and found positive for RSV-B. The distress settled with hypertonic saline nebulisations. Throughout the hospitalisation, the baby remained afebrile and haemodynamically stable. After two days, he was sent home in good condition and was doing well on weekly follow-ups for a month.
Case 4
A three-month-old female baby, born at term weighing 2.7 kg, with no significant perinatal history, was brought in with complaints of a runny nose, noisy breathing for two days, and cough for one day associated with post-tussive vomiting. The baby was admitted with respiratory distress in the form of chest retractions and tachypnoea; however, her SpO2 was maintained at room air. Bilateral wheezing and crepitations on auscultation were noted, and the Downe’s score was 4. The baby, however, did not have any other features of sepsis, and her cardiac examination showed a systolic murmur for which 2D echocardiography was done and revealed a patent foramen ovale. Hence, she was managed symptomatically. The clinical examination indicated viral aetiology; therefore, a throat swab for RSV was performed and found positive for RSV-B. The distress resolved with hypertonic saline nebulisations. Throughout the hospitalisation, the baby remained afebrile and haemodynamically stable. After three days, she was sent home in good condition and did well on weekly follow-ups for a month. The relevant case details are summarised in (Table/Fig 4).
The RSV is a member of the Paramyxoviridae family and contains a continuous, single-stranded, negative-sense Ribonucleic acid (RNA) genome (3). Human RSV (hRSV) is the most common cause of bronchiolitis and pneumonia in children under 12 months of age (4). More severe disease in the youngest infants is thought to be related to decreased levels of maternally derived RSV-specific antibodies and physical, immune, and viral factors. The severity of RSV infection in a young infant with augmented disease induced by the inactivated RSV vaccine developed in the 1960s first suggested the role of the immune response in the pathogenesis of RSV in infants (5). The potential importance of the host’s immune response to the disease has been supported by the observation that RSV is not generally invasive or cytopathic (5).
The RSV accounts for up to 16% of children hospitalised in India for Acute Respiratory Infections (ARI), with the highest incidence in infants under six months of age (6). Data from a community-based study in India showed RSV-associated incidence of hospitalisation per 1000 child years was 3.2 among children <5 years of age (6). In India, almost 2.5 million children die each year, with ARI accounting for one-fifth of these deaths (7). RSV is mainly spread through aerosols or direct contact with infected surfaces, where the virus can remain virulent for hours. RSV manifests as rhinorrhoea, nasal congestion, cough, sneezing, and occasionally fever and myalgia. After the virus has replicated in the nasopharynx during the first 4 to 5 days of incubation, it can cause LRTI. Three of our four babies had features of upper respiratory tract infection and later developed LRTI signs. Preterm delivery, Chronic Lung Disease (CLD), haemodynamically significant Congenital Heart Disease (CHD), age less than three months, neuromuscular abnormalities, and immunodeficiency are risk factors for severe illness and fatality in RSV infection (8). In support of this, two of cases, who were preterm and low birth weight, had severe illness. LRTI may develop in upto 40% of infected neonates with features of fast breathing, wheezing, persistent coughing, and difficulty feeding, which was similar to all four cases. Bronchiolitis, the most common LRTI caused by RSV, is characterised by hyperinflation, atelectasis, and wheezing in young infants. In severe cases, it may also manifest as viral pneumonia, hypoxia, lethargy, apnoea, and acute respiratory failure (9). Wheeze was the predominant finding in three of present cases. Only one baby developed severe illness, needing HFNC support.
Clinical suspicion of RSV-induced LRTI, particularly bronchiolitis, relies on clinical and epidemiological features in infants and young children. Laboratory confirmation and imaging studies are essential to differentiate RSV from other disorders. Specific testing for RSV can be done by rapid antigen testing, PCR-based testing, and viral culture. Although nasal wash yields the best results, a nasopharyngeal swab is commonly used and considered adequate (10),(11). Although viral culture is the standard for definitive diagnosis, it can take up to two weeks. PCR-based testing is increasingly preferred due to its rapid availability of results, ease of testing, and a higher sensitivity rate than rapid antigen testing. PCR-based tests carry the disadvantages of being expensive and requiring specialised equipment to process the sample. Rapid Antigen Detection Tests (RADT) can be an alternative to PCR-based tests when PCR is not feasible. Although RADTs are quick and inexpensive, they are less sensitive and carry a higher false-negative rate (12). In present cases, authors used a PCR-based test to identify RSV RNA by analysing nasopharyngeal swab samples. Diagnosis of RSV in two of present cases helped in the discontinuation of i,v. antibiotics.
Treating LRTI caused by RSV is primarily supportive, including frequent monitoring and maintaining fluid balance and providing respiratory support as and when needed (13). Treatment in neonates is extrapolated from the management of infants. In children, not all cases are admitted to the hospital, and only those with severe illness are admitted; however, in neonates, the scenario is different; all babies would need admission for a workup of neonatal sepsis (13).
In non severe cases, maintaining hydration and relieving nasal obstruction are the mainstays of treatment. Two of babies received similar care. However, in severe cases, oxygen and respiratory support are provided based on the child’s clinical status to maintain a target SpO2 of 92% in neonates (14). Two of present cases needed oxygen support, out of which one had a severe illness requiring HFNC. Hypertonic saline, bronchodilators, and glucocorticoids are not routinely recommended (13),(14). Ribavirin is an Food and Drug Administration (FDA)-approved nucleoside analogue, but it is not recommended for neonates or infants (13),(15).
Nirsevimab is a monoclonal antibody recommended for prophylaxis at the beginning of an RSV season, which protects for around five months (16). It was approved by the United States FDA in 2023 and has been recommended as a preferred choice over palivizumab (17). It has been intended to be used by the Centre for Disease Control (CDC) and the American Academy of Paediatrics in healthy infants under eight months and those with risk factors. A single 50-milligram intramuscular dose is recommended (18). However, it has yet to be made available in India. Live attenuated vaccines are under development for infants (15).
The present case series highlights the diagnosis and management of RSV-related respiratory infections in neonatal and post-neonatal babies in India. Early detection, prevention, and ongoing research are vital to mitigating the impact of RSV on this vulnerable population.
The authors would like to acknowledge the Head Dr. Vinayaka G, Dr. Manjunathaswamy R, and other staff involved in managing present cases.
DOI: 10.7860/JCDR/2024/68757.19000
Date of Submission: Nov 24, 2023
Date of Peer Review: Dec 14, 2023
Date of Acceptance: Dec 27, 2023
Date of Publishing: Feb 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. No
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Nov 25, 2023
• Manual Googling: Dec 16, 2023
• iThenticate Software: Dec 25, 2023 (12%)
ETYMOLOGY: Author Origin
EMENDATIONS: 6
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