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

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On Sep 2018

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On Sep 2018

Dr. Kalyani R

"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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Dr. Saumya Navit

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Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

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" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
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Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
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.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
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
(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.
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)
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.
On April 2011

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
On Jan 2020

Important Notice

Case report
Year : 2007 | Month : June | Volume : 1 | Issue : 3 | Page : 163 - 167 Full Version

Tuberculous Osteomyelitis Of Sternum: A Case Report

Published: June 1, 2007 | DOI:

Department of Orthopaedics, Dr.RML Hospital, NewDelhi, India.

Correspondence Address :
Dr. Jain V K., Department of Orthopaedics, Dr.RML Hospital, NewDelhi, India.


Primary mycobacterial infection of the sternum is extremely uncommon. We present a case of tuberculous osteomyelitis of sternum successfully treated with four drug antituberculous therapy. Tuberculous sternal osteomyelitis is rare entity and one should suspect tuberculosis in a case of chronic draining sinus.


Sternum; Tuberculosis; Osteomyelitis

Sternal tuberculous osteomyelitis is exceedingly rare. Kelly and Chettyreviewed the world literature till 1985 and found only 6 cases of sternal tuberculosis (1).
Through various search engines (Pubmed, Google, Embase, Altavista) we found fewer than 35 cases of sternal tuberculosis in the world English literature (2),(3),(4),(5),(6),(7),(8). We report a case of sternal tuberculosis with draining sinus.

Case Report

An -18-year-old boy from low socio economic background presented with two months history of pain and draining sinus over the sternum. The pain had started insidiously, and gradually worsened with time. The pain was dull and aching and the patient reported it as a 5 on the scale of 1-10 with 10 being the most severe. The pain was non-radiating and patient reported no pain elsewhere, the pain was relieved by anti inflammatory medications and was aggravated by physical activity. There was associated history of fever, weight loss, loss of appetite, night sweats, malaise and fatigue. There was no history of trauma. The patient had no history of previous illness, injuries and or surgery. His father was treated for pulmonary tuberculosis in the past. There was no history of cough or dyspnoea. On physical examination, the patient patient was ill and reported moderate to severe pain in the sternal region. Physical examination revealed sinus over the sternum. The sinus was of about less then a cm in size and draining serous material. The sinus was extended up to the bone and adhered to the underlying tissues.
On palpation and percussion, there was tenderness over sternum. However there was no tenderness over spine and para spinal muscles in the thoracic region. The range of motion of spine was within normal limits. There was no lymhadenopathy. The abdomen was soft and non tender with no organomegaly. Other systems were normal. Laboratory findings revealed elevated erythrocyte sedimentation rate (ESR) of 50 mm (Westergren method) after one hour and a positive C- reactive protein (CRP) test. A mantoux tuberculin skin test (purified protein derivative, 5 tuberculin units) was positive with 14 mm of induration observed 48 hours after administration. A plain chest radiograph posterior-anterior and lateral views, showed no lung infiltration, pleural effusion, enlargement of hilar lymph nodes and any bone involvement. A sinus tract biopsy was taken blindly under local anesthesia and histologic examination of the biopsy showed caseous necrosis with an accumulation of epithelioid cells and Langhan’s giant cells, The diagnosis was compatible with tuberculosis(Table/Fig 1). Ziehl -nelsen stain was positive for Acid Fast Bacilli (AFB) and a positive culture for AFB was pesent on microbiologic examination.

On Magnetic Resonance Imaging (MRI) T2 and T2 STIR images taken in different planes showed destruction, soft tissue swelling, caseation and cold abscess formation. Soft tissue swelling and expansion were seen as T2 hyperintensity, while caseation and necrosis were seen as T2 hypointense lesion (Table/Fig 2),(Table/Fig 3), (Table/Fig 4), (Table/Fig 5).
The patient received 4 months of anti-tubercular chemotherapy, consisting of four drugs (isoniazid [INH], pyrazinamide, ethambutol, and rifampicin). He was given 3 drugs (INH, rifampicin and ethambutol) in the next four months and 2 drugs (INH and rifampicin) for 10 months. His fever was subsided after 2 months of treatment and at the end of anti- tuberculous treatment, the sinus healed without any complications his appetite and growth indices improved significantly.


The sternum as the site of infection is infrequently encountered and tuberculous sternal osteomyelitis is even rarer. Tuberculosis of bones and joints accounts for 1–3% of patients with tuberculosis and isolated sternum tuberculosis representing less than 1% tubercular osteomyelites (9),(10). Less than thirty five cases have been reported so far in the world literature (2),(3),(4),(5),(6),(7),(8) In a large series from india, by Tuli and Sinha, out of 980 cases of osteoarticular tuberculosis, 14 (1.5%) were found to be due to tuberculosis of the sternum (11) In a review of 417 tuberculosis (TB) patients, Davies et al reported only two cases of sternal tuberculosis (12). Since 1985, sternal TB has been reported in association with spontaneous fracture of sternum, disseminated tuberculosis, diabetes mellitus and post coronary by pass surgery. Atypical mycobacteria are known to cause post operative infection (13),(14). Sternal osteomyelitis of tuberculous origin is generally caused by reactivation of latent foci of primary tuberculosis formed during hematogenous or lymphatic dissemination, in contrast to pyogenic osteomyelitis. Direct extension from contiguous mediastinal lymph nodes has also been described (2) The known risk factors for tuberculosis are underlying debilitating disorders, corticosteroid therapy, malnutrition, low socio-economic status, and ethanol abuse, history of exposure to tuberculosis, HIV infection and immunocompromised states (11). Similarly the index patient also belongs to low socio-economic class. Sternal TB presents insidiously predominantly with pain and swelling. Concomitant extrasternal tuberculosis has been reported in 8 out of 20 cases reviewed by Mclellan et al (15). Sternal TB has been predominantly described in adult patients as in our case however there are few paediatric cases in record. Sternal tuberculosis has also been reported after BCG vaccination in paediatric age group. Kato et al and corrales et al reported sternal TB in 9 month and 13 month old child respectively(16),(17). Imaging technique as seen in index patient plays an important role in diagnosis and follow up. According to Tuli and Sinha(11) , radiological signs occur much later than the presenting clinical features, and abscesses or sinuses are present much before the focus is detected radiologically, similarly in the index patient chest radiograph did not reveal any lesion. The Computed tomography (CT) scan is more sensitive for anatomical localization and in detecting osseous destruction and soft tissue abnormalities. Khalil et al reviewed the utility of CT scan findings for the diagnosis of chest wall TB and described characteristic ring enhancing hypodense soft tissue lesion (18) Atasoy et al suggested the role of Magnatic Resonance Imaging (MRI) for detecting early marrow and soft tissue involvement due to high contrast resolution of MRI(19). Tuberculous osteomyelitis is characterized by low signal replacement of the normal marrow fat signal on T1-weighted images, with high signal intensities on T2-weighted images and enhancement on T1-weighted images (20).However early diagnosis is established with microbiologic and histopathologic examination. In the present case, biopsy was useful to confirm the presence of TB or exclude other conditions such as pyogenic infections and malignancy. Possible complications of sternal tuberculous osteom


Kelly CA, Chetty MN. Primary sternal osteomyelitis. Thorax. 1985;40(11):872-3.
Sharma S, Juneja M, Garg A. Primary tubercular osteomyelitis of the sternum. Indian J Pediatr. 2005;72(8):709-10.
Wang TK, Wong CF, Au WK, Cheng VC, Wong SS. Mycobacterium tuberculosis sternal wound infection after open heart surgery: a case report and review of the literature. Diagn Microbiol Infect Dis. 2007:12; [Epub ahead of print]
Gopal K, Raj A, Rajesh MR, Prabhu SK, Geothe J. Sternal tuberculosis after sternotomy for coronary artery bypass surgery: a case report and review of the literature. J Thorac Cardiovasc Surg. 2007;133(5):1365-6.
Ekingen G, Guvenc BH, Kahraman H.Multifocal tuberculosis of the chest wall without pulmonary involvement. Acta Chir Belg. 2006;106(1):124-6.
Zhao X, Chen S, Deanda A Jr, Kiev J.A rare presentation of tuberculosis. Am Surg. 2006;72(1):96-7.
Bandyopadhyay SK, Moulick A, Ghosal J, Dutta A. Pre sternal cold abscess. J Assoc Physicians India. 2005;53:866.
Rivas P, Gorgolas M, Gimena B, Sousa J, Fernandez-Guerrero ML. Sternal tuberculosis after open heart surgery. Scand J Infect Dis. 2005;37(5):373-4.
Boh JA, Janner D. Mycobacterium tuberculosis sternal osteomyelitis presenting as anterior chest wall mass. Pediatr infect Dis J 1999;18:1028-29.
Watts HG, Angrles L, Lifesto RM.Current concepts review: tuberculosis of bones and joints. J Bone Joint Surg Am 1996; 78:288–298.
Tuli SM, Sinha GP. Skeletal tuberculosis "Unusual" lesions. Indian Journal of Orthopaedics 1969; 3: 5-18.
Davies PD, Humphries MJ, Byfield SP, Nunn AJ, Darbyshire JH, Citron KM et al. Bone and joint tuberculosis. A survey of notifications in England and Wales. J Bone Joint Surg Br. 1984 66-B: 326-330.
Samuels LE, Sharma S, Morris RJ, Solomon MP, Granick MS, WoodCA et al. Mycobacterium fortuitum infection of the sternum.Revi

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