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

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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.
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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.
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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.
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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 : 2007 | Month : December | Volume : 1 | Issue : 6 | Page : 500 - 504 Full Version

Role of Chlamydia trachomatis in the Aetiological Profile of Chronic Conjunctivitis in a Tertiary Care Hospital


Published: December 1, 2007 | DOI: https://doi.org/10.7860/JCDR/2007/.145
VANATHI M*, SHARMA A**, SATPATHY G**, PANDA A*, ANGRA S K*

*Department of Cornea Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi 110029, India,**Department of Ocular Microbiology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi 110029, India

Correspondence Address :
Dr Gita Satpathy, MD, Professor. Department of Ocular Microbiology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi 110029, India.E-mail: gitasatpathy@hotmail.com

Abstract

Background: The aetiological profile of chronic conjunctivitis in North-Indian patients is poorly understood; and clinical assessment remains the diagnostic criteria without supportive laboratory investigations. This study was conducted to find out the presence of Chlamydia trachomatis and other bacteria in the conjunctiva of patients with clinically diagnosed chronic conjunctivitis, attending the out-patient department of a tertiary eye-care hospital in Delhi.

Methods: One hundred eyes from 50 patients of chronic conjunctivitis and an equal number of apparently healthy controls were included in the study. Conjunctival swabs were collected from the superior/inferior palpebral conjunctiva and eye-lid margins with a sterile wet cotton swab for chlamydial antigen detection by direct immunofluorescence (DFA), bacterial culture, and cytology.

Results: Patients with chronic conjunctivitis revealed 38% positivity for C.trachomatis antigen alone, and 15% for mixed bacterial and chlamydial infections, while in the control group, only 2 eyes were positive for chlamydial antigen, and 19 for other bacterial flora. Among bacterial isolates (28), coagulase –ve staphylococci (21) predominated, followed by coagulase +ve staphylococcus (4), dipheroids (2), and aerobic spore-bearing bacilli (1). In cytology (with geimsa stain), inflammatory response was observed; the combination of polymorphs with lymphocyts (62) outnumbered the combination of polymorphs with eosinophils (37) in the case of chronic conjunctivitis.

Conclusions: Findings of the present study suggest that C.trachomatis continues to be the leading cause of chronic conjunctivitis in North India. However, surveillance involving larger groups of patients is warranted to further augment our observation.

Keywords

Chronic conjunctivitis, Chlamydia trachomatis, direct immunofluorescence assay

Introduction

Chronic conjunctivitis is an ocular surface manifestation of diversified aetiology, ranging from microbial infections to allergy, topical medication, irritants, acne rosacea, malignancy, contact lens use, and floppy eyelid syndrome, besides many others (1),(2),(3),(4),(5). It is characterized by conjunctival hyperaemia and/or discharge, usually persisting for over 2-4 weeks. Reports from different geographic regions have varied aetiology. However, microbial origin remains the leading cause, more so, in developing countries with relatively inferior hygienic conditions (6),(7),(8). Limited studies have been carried-out to unveil the aetiology of chronic conjunctivitis in India, but most cases in the country still get symptomatic treatment, without ascertaining the exact cause through appropriate laboratory confirmations (9),(10).

A case control study was therefore, designed to gauge the magnitude of bacterial aetiology with due emphasis on Chlamydia, in out-door patients of chronic conjunctivitis attending a tertiary-care hospital in North-India.

Material and Methods

Selection of patients
One hundred eyes of 50 consecutive patients of chronic conjunctivitis with complaints of itching, redness, irritation and discharge, reporting to the outpatient department of Dr. R.P. Centre for Ophthalmic Sciences the Centre, were recruited for the study. One hundred healthy eyes of 50 normal individuals were taken as controls. Eyes with chronic conjunctivitis of known aetiology i.e. vernal catarrh, phylectenular conjunctivitis, chemical injuries, topical medications, chronic dacrocystitis, and keratoconjunctivitis sicca, were excluded. The mean age of the cases was 32.25 ± 23.83 (9-56 years, 42 males and 8 females), and that of the controls was 32.5 ± 20.34 (12-53 years, 41 males and 9 females). An informed consent was obtained from all patients. A careful clinical examination, including slit lamp biomicroscopy of the anterior segment of the eye and ocular adnexa, was done.

Specimen collection and processing
Conjunctival swabs were collected from the superior/ inferior palpebral conjunctiva with sterile cotton swabs, and rolled onto glass slides to make the smear for (I) Gram Stain (II) Giemsa Stain (IIII) C.trachomatis antigen detection. Separate conjunctival specimens in sterile cotton wool swabs, were collected and inoculated on blood and chocolate agars for bacterial culture.

While bacterial isolates were identified using recommended biochemical tests (11), C.trachomatis antigen was detected using a monoclonal based direct immunofluorescence assay, using the commercial kit (Micro-Trak, Syva, UK) as per the manufacturer’s instructions (12). Briefly, the conjunctival smears were brought to room temperature. The smears were covered with 30μl of the FITC conjugated C. trachomatis murine monoclonal antibodies, and incubated for 15 minutes at room temperature. The slides were washed in distilled water, air dried, mounted, and observed under the 100X objective of a fluorescent microscope. (NIKON, Japan). A positive and negative control smear (provided with the kit) was included with the test.

Results

In Giemsa stained smears, conjunctival smears of 94 eyes from cases and 20 eyes from controls showed polymorphonuclear cells (PMN). Mixed inflammatory response of PMN and lymphocytes was seen in 62 eyes from cases, and in 3 eyes in controls. Eosinophilic predominance (allergic response) was seen in 37 eyes in cases, and 4 eyes in controls. Chlamydial Halberstaedter - Prowazek (HP) inclusion bodies were detected in 6 eyes from cases, but in none in control smears (Table/Fig 1).

In the immunofluorescence assay, Chlamydia antigen alone was detected in 38 eyes (21 patients; 17 bilateral, 4 unilateral) in the patient group, and in two eyes (unilateral) in the control group (p= < 0.0001). Chlamydial antigen detection along with bacterial culture positivity, was seen in 13 eyes (4 bilateral, 5 unilateral) in the patient group, and in 9 eyes in the control group (p value not significant) (Table/Fig 2). Of the Chlamydia antigen positive cases, 82% were above 20 years of age, whereas 18% were below 20 years of age.

Bacterial culture was positive in 28 eyes from the patient group and in 19 eyes from the control group (p value not significant) (Table/Fig 3). Staphylococcus was the predominant organism. Coagulase negative Staphylococci were isolated in 21 cases, coagulase positive Staphylococci were isolated in 4, Diphtheriods were isolated in 2, and Aerobic Spore Bearing bacilli was isolated in one, from patients of chronic conjunctivitis (Table/Fig 3).

Discussion

Chronic conjunctivitis affects millions of people across the globe, it and requires substantial medical attention to prevent long term sequlae. Different studies have implicated diversified aetiology, but infections remain one of the main causes, more so in developing countries (1).

A cascade of diagnostic methods including non-invasive exfoliative cytology, Giemsa/ Gram’s staining, immunofluorescence, and microbial culture in conjunction with clinical wisdom, have been frequently used to establish the aetiology of chronic conjunctivitis. Cytological examination of the conjunctival scrapings revealed the nature of the inflammatory response. Predominance of neutrophils and lymphocytes usually point to bacterial and viral aetiology, while eosinophilic predominance occurs in allergic conjunctivitis (2),(6),(7),(8).

In a study carried out in Wisconsin (6), the aetiological agents in chronic conjunctivitis included chlamydiae (19%), viruses (14%), irritants (10%), allergies (7%, bacteria (7%), contact lens (7%), acne rosacea (3%), and floppy eyelid syndrome 2%. In a cytological examination, Cvenkel and Globocnik (2) found neutrophils in as high as 37%, eosinophils in about 20%, and lymphocytes in just 13% cases of chronic conjunctivitis. Coagulase negative staphylococcus was the most pre-dominant pathogen (`25%), and chlamydia was implicated in less than 7% cases in their study. On the contrary, our present study revealed  38% positivity for C.trachomatis, and 13% for those mixed with bacterial pathogen. In addition, 15% of them had positivity for bacteria. Previous studies from India and other Asian countries have reported a high incidence of C.trachomatis in different forms of conjunctivitis, both in adults and in children (7),(9),(10),(12),(13),(14), using the more sensitive restriction length polymorphism (RFLP) and nested polymerase chain reaction (PCR). Madhavan reported `21% positivity for C.trachomatis and adenoviral aetiology in 13.8% in cases of conjunctivitis and retinal inflammation in Southern India (7). Szymulska and Zagorsk (15) also reported high positivity ( 34%) of chlamydia in cases of chronic conjunctivitis, using the same method (DFA) as in the present study.

The high incidence of chlamydial aetiology in this part of India could be attributed to poor hygienic conditions and persistence of oculogenital chlamydial infections in the population, at a much higher rate. With regards to bacterial aetiology, we found a high incidence of coagulase negative staphylococci, but there was no significant difference between the cases and the control group. Staph. Epidermidis was isolated in 21% and in 18%, in cases and controls respectively. However, superadded bacterial infection might have a role in pathogenesis in chronic conjunctivitis cases, due to Chlamydia.

Our finding is in concordance with most previous reports, although Grabson et al. (16) found very high percentage of coagulase negative Staphylococci isolation from normal and inflamed conjunctiva. Assessment of allergic aetiology in the present study, was based on the observation of eosinophilic response in cytology, which was similar to previous observations (4),(8).

It is clear from the results of the present study and those reported elsewhere, that chlamydia remains an important aetiological agent in clinical cases of chronic conjunctivitis, although secondary bacterial infections may aggravate the disease. Extensive studies in diff

Key Message

1.Northern India has been a major endemic focus of trachoma in the past. Though there has been a major reduction in trachoma related blindness in India, hospital records still reflect a substantial number of diagnoses of trachoma.
2.This study highlights that chlamydia is still an important infective aetiological agent in chronic conjunctivitis.

References

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Prost A, Negrel AD. Water, trachoma and conjunctivitis. Bull World Health Org 1989;67:9–18.
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Cvenkel B, Globocnik M. Conjunctival scrapings and impression cytology in chronic conjunctivitis. Correlation with microbiology. Eur J Ophthalmol 1997;7:19–23.
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Schwartz LK, Gelender H, Forster RK. Chronic conjunctivitis associated with 'floppy eyelids'. Arch Ophthalmol 1983;101:1884–8.
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Leibowitz HW, Pratt MV, Flafstad IJ, Berrospi AR, Kundsin R. Human conjunctivitis I. Diagnostic evaluation. Arch Ophthalmol 1976;94:174–9.
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Bielory L. Allergy and immunologic disorders of the eye. Part II: ocular allergy. J Allergy Clin Immunol 2000;106:1019–22.
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Rapoza PA, Quinn TC, Terry AC, Gottsch JD, Kiessling LA, Taylor HR. A systematic approach to the diagnosis and treatment of chronic conjunctivitis. Am J Ophthalmol 1990;109:138–42.
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Madhavan HN. Laboratory investigations on viral and C. trachomatis infections of the eye: Sankara Nethralaya experiences. Indian J Ophthalmol 1999;47:241–6.
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Butrus S, Portela R. Ocular allergy: diagnosis and treatment. Ophthalmol Clin North Am 2005;18:485–92.
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Limburg H, Vaidyanathan M, Bandopadhyaya P, Satpathy G, Verma L, Mutthy GVS, et al. (The trachoma study group). Current trends in trachoma in a previously hyper-endemic area. Indian J Ophthalmol 1998;46:217–20.
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Mehrotra AN, Awasthi NN, Mathur BD, Mishra IB. Prevalence of eye diseases amongst school going children in rural and urban communities of Jhansi, Bundelkhand. Indian J Prev Soc Med 1978;9:161–3.
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Collee JG, Miles RS, Watt B. Tests for identification of bacteria. In: Collee JG, Fraser AG, Marmion BP, Simmons A, editors. Practical medical microbiology. Edinburgh: Churchill Livingstone; 1999. p. 131–40.
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Mohile M, Deorari AK, Satpathy G, Sharma A, Singh M. Microbiological study of neonatal conjunctivitis with special reference to C. trachomatis. Indian J Ophthalmol 2002;50:295–9.
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Tables and Figures
[Table / Fig - 1] [Table / Fig - 2] [Table / Fig - 3]

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