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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
Original article / research
Full Version
Radiological Changes in the Hands and Feet of Leprosy Patients with Deformitie
Correspondence Address :
Dr. Balachandra S. Ankad
Assistant Professor, Department of Dermatology,
S. Nijalingappa Medical College, Navanagar,
Bagalkot- 587102, Karnataka, India.
E-mail: drbsankad@gmail.com
Phone: +919980410056
Context: Leprosy is a social disease and it is perceived in the society due to deformities. Bone changes are common in leprosy.
Aim: To study the radiological changes in the hands and feet in leprosy patients with deformities.
Settings and Design: This was an observational study done in the Department of Dermatology.
Methods and Material: This study was carried out for 24 months and it included 50 leprosy patients who were associated with deformities. The radiological changes were studied by taking roentgenograms (X-rays) of the hands and feet.
Statistical Analysis Used: The statistical analysis of the descriptive data, that included the number and percentages, was done for all the categories.
Results: Among 50 patients (34 males and 16 females) overall, the radiological changes were seen in 48 patients. The radiological changes found were specific, nonspecific and osteoporotic in 31, 48 and 27 patients respectively. Only 2 patients did not show any bone changes. Male patients, especially manual labourers, showed more bone changes. There was no significant difference in the bone changes among the various types of leprosy.
Conclusions: Though leprosy is an ancient disease, it still continues to be the most feared, due to deformities. The bone changes with deformities are preventable, since all these are not due to the disease itself. The study of the radiological changes may help the clinician in formulating methods for the management of the disease and in preventing the permanent loss of function and the occurrence of deformities and disabilities.
Leprosy, Deformities, Radiological changes
Leprosy is a chronic disease which is caused by Mycobacterium leprae, which is infectious in some cases, and affecting the peripheral nervous system, the skin, bones and joints and certain other tissues.
Leprosy is a disease of great antiquity (1). It is considered to be important mainly because of its potential to cause permanent and progressive physical deformities with serious social and economical consequences (2).
Leprosy continues to be an important public problem in most parts of Asia, Africa and Latin America. It is widely prevalent in India. India alone represents 64% of the prevalence and 78% of the new case detections worldwide (3).
About 25% of the leprosy patients who are not treated at the early stages of the disease develop deformities of the hands and feet (4). About 80% of the joint lesions are in the metatarso-phalangeal joints of the foot or in the inter-phalangeal joints of the hands and feet (5). The frequency of the bone changes which has been recorded in different studies has varied from 15% to 95% (6).
A number of factors influence the occurrence and the progress of deformities in leprosy patients. These are related to the age, sex and occupation of the patient, the duration and type of disease, nerve involvement and environmental factors (7).
The main aim of this study was to study the radiological changes in the hands and feet in leprosy patients with deformities.
50 cases of leprosy patients who attended the Department of Dermatology were selected for the study. Ethical clearance for the study protocol was obtained from the institutional ethical committee. An informed consent was obtained from all the patients.
A detailed clinical examination was carried out in all the patients and they were provisionally diagnosed as lepromatous (LL), borderline lepromatous (BL), borderline (BB), borderline tuberculoid (BT), tuberculoid (TT) and polyneurotic leprosy (PN).
The diagnosis of the type of leprosy was confirmed by the demonstration of AFB from the slit and scrape smears. The bacteriologicalindex (BI) and the morphological index (MI) were calculated according to Ridley’s scale (8). The histopathological examination of the skin lesions in lepromatous, borderline and tuberculoid leprosy and the nerve (sural) in neural leprosy was done.
A radiological examination for the presence of the bone changes was carried out, which included antero-posterior (AP), lateral or oblique skiagrams of both the hands and feet of the patients. The skiagrams were studied in detail for the specific and non-specific bone changes and for osteoporosis.
The statistical analysis of the descriptive data that included the number and percentages was done for all the categories.
In a total of 50 patients, the overall incidence of bone changes was 96%. The radiological changesfound were specific, nonspecific and osteoporotic in 62%, 96% and 54% of patients respectively. Only 4% of the patients did not show any bone changes.
The youngest patient in the present study was 12 years old and the oldest was 75 years old. The maximum number of patients(13) who showed bone changes in this study belonged to the 40-49 years age group, whereas the least number of patients (2) belonged to the 10-19 years age group.
In this study, male patients comprised 68% and female patients, 32% of the total patients.
Specific bone changes in the hands and feet: In the hands, the commonest specific bone change was primary periosteitis (24%) and in the feet, the areas of bone destruction were the commonest (28%). The other changes with their frequencies are shown in (Table/Fig 1).
Nonspecific bone changes in the hands and feet: Nonspecific bone changes were observed in 48 patients (96%). Absorptive changes were the most common among them. The absorption of the terminal phalanges was present in 48 patients (96%). The other non specific changes with their frequencies are shown in (Table/Fig 2).
Bone changes and the type of leprosy: In the present study, 30 patients had BT (60%) 12 had BL (24%), 5 had PN (10%), 2 had LL (4%) and 1 had BB (2%) type of leprosy. None of the patients belonged to the TT spectrum.
The bony changes with respect to the type of leprosy are shown in (Table/Fig 3).
In all the 50 patients, the overall incidence of the bone changes was 96% in the present study whereas in the study of Choudhuri et al (9), Thappa et al (6) and Carayon (5), it was 87.3%, 82.9% and 60-80% respectively. The higher incidence of the overall bone changes in the present study may be due to the fact that the study group constituted patients who had deformities.
In the present study, 62% of the patients showed specific bone changes as against 44.5 % (9), 22.4 % (6) and 34 % (10) in other studies. Enna et al (11), noticed 3-5% specific changes in hospitalized patients and Murry and Jacobson (12) observed that 15% of the patients showed specific changes.
The percentages of various specific and non-specific changes which were encountered in the present study and by other authors are depicted in (Table/Fig 4) and (Table/Fig 5) respectively.
In the present study, 30 patients belonged to the BT type and 12 patients belonged to the BL type of leprosy. There were 5, 2 and 1 patients who belonged to the PN, LL and BB type of leprosy respectively. There were 54% patients who belonged to the paucibacilary (PB) type and 46% patients who belonged to the multibacillary (MB) type of leprosy.
In the study of Choudhuri et al (9), 89% had PB leprosy and 11% had MB leprosy. In the study of Thappa et al (6) and Chhabriya et al (10), there were more patients who belonged to the MB group of leprosy.
In a study by Schipper et al (13), tBT/TT type of leprosy was seen in 41% of the patients, the LL/BL type was seen in 47% of the patients and thPN type was seen in 12% of the patients. Similar observations were made by Thappa et al (14)(Table/Fig 6).
In the above mentioned studies, the commonest type of leprosy was MB, whereas in the present study the PB type was the commonest. This could be because the patients who had deformities were included and because the deformities were more common in the borderline spectrum(Table/Fig 7).
Specific changes were seen in all the patients who belonged to the LL and BB types of leprosy (100%), whereas they were seen in 66.6%, 60% and 56.6% patients of the BL, PN and BT types of leprosy respectively(Table/Fig 8).
In the study of Choudhuri et al (9), the LL type showed an increased incidence of bone changes (75% specific, 100% nonspecific and 75% osteoporosis) as compared to BT leprosy (45% specific, 76.5% nonspecific and 35% osteoporosis)(Table/Fig 9).
In the present study, the patients in the BT group showed 56.6%, 96.66% and 50% specific, nonspecific and osteoporotic changes respectively. This was almost similar to the frequency which was found in the study of Choudhuri et al (9). However, in the present study, all the patients with the LL type showed specific (100%) and nonspecific (100%) changes.
In the study of Chhabriya et al (10), specific changes were observed with a decreased incidence (LL-37%, BT-25%, BB-25% and PN- 50%), whereas the present study showed an increased incidence of specific changes among the various types of leprosy (LL-100%, BL-66.6%, BB-100%, BT-56.6% and PN-60%).
In the study of Thappa et al (6), the BT, BL and LL types showed 64.3%, 80% and 26.7% nonspecific changes and in the study of Choudhuri et al (9), the BT, BL and LL types showed 76.5%, 50% and 100% non-specific changes respectively. In the present study, a similar frequency of nonspecific changes was observed among the different types of leprosy i.e., BT (96.6%), BL (91.6%), LL (100%) and PN (100%).
In the study of Chhabriya et al (10), osteoporosis was present in 50% of all the patients and in the study of Choudhuri et al (9), itwas present in 75%, 50% and 35% of the LL, BL and BT patients respectively. In the present study, osteoporosis was observed with an increased incidence among the different types of leprosy (BT-50%, BB-100%, BL-58.3% and PN-80%). However, none of the patients in LL type showed osteoporotic changes.
Thus, the various bone changes were observed in the present study, which were higher in frequency and were probably attributable to the types of leprosy and also to the study population which consisted of patients with deformities.
Though leprosy is an ancient disease, it still continues to be the most feared due to deformities. The bone changes with deformities are preventable, since all these are not due to the disease itself. The study of the radiological changes may help clinicians in formulating methods for the managemenand in prevention of the permanent loss of function and the occurrence of deformities and disabilities.
Among the 50 leprosy patients who were studied, radiological changes in the form of specific, nonspecific and osteoporotic bone changes were found in 31, 48 and 27 patients respectively.
This study may help clinicians in formulating methods of management and in preventing the permanent loss of function and the occurrence of deformities.
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