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

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Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
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Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
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On Sep 2018




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"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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Lucknow
On Sep 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,
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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.
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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.
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.


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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

Important Notice

Original article / research
Year : 2012 | Month : September | Volume : 6 | Issue : 7 | Page : 1188 - 1191

The Prevalence of Intestinal Parasitic Infestations and the Evaluation of Different Concentration Techniques of the Stool Examination

Parameshwarappa KD, Chandrakanth C, Sunil B

1. Tutor, Department of Microbiology,BIRMS, Bidar, India. 2. Associate Professor, Department of Microbiology, BIRMS, Bidar, India. 3. Assistant Professor, Department of Microbiology, MRMC, Gulbarga, India.

Correspondence Address :
Tutor, Department of Microbiology,
Bidar Institute of Medical Sciences,
Phone: +917411741148
E-mail: parameshwarappakd@gmail.com

Abstract

Aims and Objectives:
The intestinal parasitic infections which are prevalent in the developing countries may even be more important than the bacterial infections. In India, malnutrition, unhygienic conditions, the improper disposal of sewage, the non-availability of potable water supplies in the rural and the urban areas, the indifferent attitude of the population towards personal hygiene, their low socio-economic status and the low literacy rates are responsible for the high rates of intestinal parasitic infections. In view of the above facts, the present study was undertaken to assess the prevalence of the intestinal parasitic infections in the urban and the rural populations which came under a tertiary care teaching hospital.
Material and Methods:
A total of 1000 stool samples were collected from the rural and the urban populations and each stool sample was examined by: 1. Gross examination 2. Direct microscopic examination by using saline and iodine preparations and by 3. Concentration techniques like simple slat flotation, Zinc sulphate centrifugal floatation, formol-ether concentration and modified formol-ether concentration.
Results:
The prevalence of the intestinal parasitic infections was higher in the rural population. A male predominance was noted (33.29%) in both the populations. Children who were between 10-20 years of age had the highest prevalence of the parasitic infestations. The common parasite which was isolated from both the populations was Entamoeba histolytica, with a prevalence rate of 65.57%, followed by Ascaris lumbricoides.
Conclusion:
The modified formol-ether sedimentation procedure showed a high sensitivity for the parasitic detection. The supplementation of the routine method with floatation and the sedimentation technique will improve the diagnostic accuracy when this is compared to the routine method alone.

Keywords

Concentration techniques, Simple salt floatation, Zinc sulphate centrifugal floatation, Formol-ether concentration, Modified formol-ether method

How to cite this article :

Parameshwarappa KD, Chandrakanth C, Sunil B. THE PREVALENCE OF INTESTINAL PARASITIC INFESTATIONS AND THE EVALUATION OF DIFFERENT CONCENTRATION TECHNIQUES OF THE STOOL EXAMINATION. Journal of Clinical and Diagnostic Research [serial online] 2012 September [cited: 2018 Oct 20 ]; 6:1188-1191. Available from
http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2012&month=September&volume=6&issue=7&page=1188-1191&id=2442

Introduction
Parasitic infections are a major public health problem worldwide; particularly in the developing countries (1). The prevalence of the intestinal parasitic infections varies from one region to another and it also depends largely on the diagnostic methods which are employed and the number of stool examinations which are done. In India, malnutrition, unhygienic conditions, the improper disposal of sewage and the non-availability of potable water supplies in the rural and the urban areas are responsible for the high rate of intestinal parasitic infections (2). Globally, as many as 500 million people may harbour Entamoeba histolytica and several tens of thousands die each year as a consequence of fulminating colitis or amoebic liver abscesses (3). The number of people who are affected by Giardia lamblia, whipworm, roundworm and hookworm in the developing world has been estimated to be 200, 500, 700 and 800 million respectively (4). The conventional methods which are used for the detection of intestinal parasites from stool include the direct wet mount and the iodine mount. The conventional methods lack sensitivity in the detection of parasites in the stool specimens. The detection Original Article M icrobiology Sectionof parasites in the faecal specimens is enhanced by the use of concentration procedures. Various concentration techniques like simple slat floatation, Zinc sulphate centrifugal floatation, formol-ether concentration and modified formol-ether concentration are employed for the diagnosis and the epidemiologic surveillance of parasitic infections in humans. These techniques increases the detection of the helminthic eggs, larvae and the protozoan cysts. Certain techniques like formol-ether concentration have the advantages of less alteration to the organisms and an increased recovery of the Schistosoma spp. and operculated eggs. In view of the increasing polyparasitism in the developing countries, there is a need of sensitive diagnostic tools that are simple to apply and to concurrently detect different intestinal parasite species in the same stool sample. The objectives of this study were to determine the prevalence of intestinal parasitic infections among the patients who attended a tertiary care teaching hospital and to compare 4 different concentration techniques with the conventional technique in diagnosing parasitic infections.

Material and Methods

A total of 1000 patients, both symptomatic and asymptomatic, were studied for 2 years from July 2009 to July 2011. Fresh stool specimens from 500 patients who attended the tertiary care teaching hospital, Mahadevappa Rampure Medical College, Gulbarga and 500 specimens from the Rural Community Health Centre, Rajapur, Gulbarga District, were collected in sterile containers and transported to the Department of Microbiology immediately. The stool samples which were contaminated with the patient’s urine were rejected. The stool samples from the patients who had history of ingestion of kaolin, magnesia, powdered aluminum, barium, bismuth or iron were rejected. Both the formed and the unformed stools were examined freshly. Each stool specimen was examined by the following techniques.
1. Macroscopic examination:
The colour, consistency and the nature of the faeces were recorded. The stool specimens were examined for the presence of worms like Ascaris, Enterobius, proglottids of Taenia, adult Hookworm and Trichuris, either with the naked eye or with the aid of a hand lens.
2. Direct microscopic examination by using saline and iodine preparations:
On a 1mm thick microscopic slide, a small amount of stool sample was emulsified in 1-2 drops of saline or iodine solution. A cover slip was placed on it by taking care that the preparation was free of air bubbles and macroscopic debris.
3. The microscopic examination after the various concentration techniques:
a) Simple salt floatation:Briefly, about 1gm of faeces was emulsified with 3-4 ml of saturated salt solution in a 20ml conical glass test tube. It was stirred well and more salt solution was added till the container was nearly full, with the stirring being continued. Any coarse matter which floated up was removed and the tube was placed on a levelled surface with a glass slide being placed over the top of the tube, which was in contact with the fluid. It was allowed to stand for 30 minutes. The slide was removed and observed for the presence of eggs/cysts.
b) Zinc sulphate centrifugal floatation: 1g of the stool specimen was emulsified in 10 parts of tap water and it was strained through a wire gauze. The filtrate was collected in a Wassermann tube and centrifuged at 2,500 rmp. The supernatant was discarded and the sediment was re-suspended in water. This step was repeated till the supernatant became clear. To the sediment, 3-4 ml of 33% Zinc sulphate solution was added, it was mixed well and it was filled with ZnSO4 solution, about half an inch of the rim. Several loopfuls of the supernatant fluid were removed with a bacteriological loop and they were observed for parasites.
c) Formol-ether concentration: 1g of stool was emulsified in 7ml of 10% formol saline and it was kept for 10 minutes for fixation. It was then strained through a wire gauze. The filtrate was added to 3 ml of ether and it was centrifuged at 2000 rpm for 2 minutes. It was allowed to settle. The supernatant was removed and a wet mount was made of the deposit to look for parasites.
d) Formol-ether concentration which was modified by Allen and Ridely: 5 It was a modification of the formol-ether method where the centrifugation was done at 3000 rpm for 60 seconds instead of 2000 rpm for 2 min. The sediment was used for the parasitic examination.

Results

A total of 1000 stool samples were examined, out of which 276 (27.6%) samples were positive for intestinal parasitic infestation, as was observed by the different parasitic diagnostic methods. A total of 132 (26.4%) out of the 500 stool samples from the tertiary care teaching hospital and 144 (28.8%) out of the 500 stool samples from the Rural Community Health Centre were positive for parasites (Table/Fig 1). Overall, the prevalence of parasitic infections in males and females was 33.39% and 21.29% respectively (Table/Fig 2). Children who were between 10-20 years of age had the highest prevalence of the parasitic infestations (Table/Fig 3). Dual infections were seen in 55/276 patients. The most common dual infection was the infestation of the Entamoeba histolytica cysts with Ascaris eggs. Two patients showed triple parasitic infections. Both of them were infested with Entamoeba histolytica cysts, Ascaris eggs and Taenia spp eggs. Routine diagnostic methods like wet and iodine mounts poorly demonstrate parasitic infections with a sensitivity of 38% (105/276). The modified formal ether concentration technique was found to be most sensitive method in this study. The method could demonstrate 179/276 (64.85%) parasitic infestations (Table/Fig 4).

Discussion

Parasitic infestations are the major causes of morbidity and mortality in developing countries like India. The data on their prevalence and the sensitivity of various diagnostic methods help the clinicians and the microbiologists in the diagnosis and the management of the patients. Various studies have shown different prevalence rates of the parastitic infestations in different parts of India. But most of the studies had less sample sizes. In this study, 1000 samples were included, both from the rural and the urban areas to know the prevalence of the disease. The present study showed that the rural population had a higher prevalence of the parasitic infections (28.8%) as compared to the urban population (26.4%), with a p value of >0.05. This finding was in agreement with the findings of Marothi Y et al., (6). The most common parasitic infestation was that of Entamoeba hystolytica (65.57%), followed by that of Ascaris lumbricoides (Table/Fig 1). This finding was comparable to the results of Marothi Y et al., (6) and Bisht D et al., (7). The prevalence of parasitic infestations was more common in males (33.39%) as compared to that in females (21.29%, (Table/Fig 2). Marothi Y et al., (6) showed that the infestations had a female preponderance. Various studies have shown the varying sex prevalence of the parasitic infestations. However, the sex predominance for the parasite infections has still not been confirmed. The reason for the male preponderance in our study may relate to the daily activity rather than the sex predominance. Kang G et al., (8), in their study, showed that he commonest parasitic infection was Hookworm (61.5%), followed by Giardia (53.8%) and Cryptosporidium (39.7%). But the present study did not show any Cryptosporidium spp in any sample. The results of Kang G et al., (8), showed that older chil 3dren and adults had a higher prevalence of parasitic infections as compared to preschool children. These results were comparable to those of the present study (Table/Fig 5). The prevalence of dual infections was high in the present study (19.9%) as compared to that in Marothi Y et al’ study et al., (6) (1%). The numbers of the triple parasitic infestations were also high in the present study (0.7%) as compared to that in Marothi Y et al., study (6). The maximum number of parasites which was shown in a single sample was 3 (Entamoeba histolytica cysts, Ascaris eggs and Taenia spp eggs). The diagnosis of parasitic infections in humans is challenging and it requires skills to identify and to differentiate them from one another. The routine diagnostic procedures lack sensitivity. The concentration methods should be performed routinely for the examination of parasites. Concentration permits the detection of the organisms which are present in small numbers: these may be missed by using direct wet mounts. The organisms that can generally be identified by using concentration procedures include: helminth eggs and larvae; cysts of Giardia lamblia, Entamoeba histolytica / Entamoeba dispar, Entamoeba coli, Endolimax nana, Blastocystis hominis and Iodamoeba butschii; and the oocysts of Isospora belli. The present study showed that there was a significant increase in the number of parasites which were detected by following the application of the concentration methods. The inclusion of two or three different concentration techniques with different principles into the routine diagnostic tests increased the sensitivity. Moges F et al., (9) compared the formol-ether concentration technique with the routine iodine preparation and the Formol acetone concentration techniques. They showed that the formol-ether concentration technique was more sensitive as compared to the other methods. The present study found that 64.5% of the cases were detected by the formol-ether method, thus making it the most sensitive method. The inclusion of the modified formol-ether and the simple salt flotation techniques in the routine practice increases the sensitivity of the parasite detection. All the three methods are cost effective and they can be performed in rural settings with minimum basic infrastructures.

Conclusion

The prevalence of parasitic infections remains high. Because of malnutrition, unhygienic conditions, the improper disposal of sewage and the non-availability of potable water supplies in the rural areas, the prevalence of the parasitic infections remains high. The modified formol-ether technique and the simple salt flotation technique can be used in combination to increase the diagnostic sensitivity.

Acknowledgement

We thank Dr. Rudresh SM, Assistant Professor, Department of Microbiology, Bidar Institute of Medical Sciences, Bidar for his suggestions, detailed analysis and critical review of the manuscript.

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Marothi Y, Singh B. The prevalence of intestinal parasites at Ujjain, Madhya Pradesh, India: a five-year study. Afr J Microbiol Res 2011;5(18):2711-14.
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ID: JCDR/2012/4662:2442

Financial OR OTHER COMPETING INTERESTS:
None.
Date of Submission: Jun 08, 2012
Date of Peer Review: Jun 27, 2012
Date of Acceptance: Aug 07, 2012
Date of Publishing: Sep 30, 2012

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