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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
Association of Human Leukocyte Antigen-Cw6 in Psoriasis Patients with Disease Severity and Morphological Patterns: A Cross-control Study in a Tertiary Care Referral Centre in Eastern India
Correspondence Address :
Dr. Akhilesh Behra,
Shailendra Nagar, Bank Colony, Raigarh-496001, Chhattisgarh, India.
E-mail: drakhileshbehra@gmail.com
Introduction: Psoriasis is a multifactorial disorder in which genetic and environmental factors play an essential role in disease pathogenesis. The Human Leukocyte Antigen-Cw6 (HLA-Cw6) allele has shown the strongest genetic association with this condition across several populations studied.
Aim: To estimate the risk of HLA-Cw6 association with psoriasis compared to the control group and its association with the severity of psoriasis expressed as Psoriasis Area and Severity Index (PASI) score and morphological patterns.
Materials and Methods: A cross-control study was conducted from March 2014 to February 2015 in a tertiary care centre in the eastern part of India. All patients who were diagnosed clinically as psoriasis and gave written informed consent were included in the study. Healthy controls were taken to compare the HLA-Cw6 after duly signing the informed consent for detailed history, clinical examination, PASI score, and digital photographs of lesions were taken. A blood sample was taken from patients and the control for HLA-Cw6 typing by sequence-specific Polymerase Chain Reaction (PCR) method. Data was analysed by appropriate statistical test (Chi-square test) using R statistical software.
Results: A total of 100 patients with psoriasis and 100 controls were recruited, of which 61 were positive for HLA-Cw6 among the psoriasis group and nine in the control group. Positivity of the HLA-Cw6 allele was significantly higher in psoriasis cases (n=61) compared to normal individuals (n=9) (p-value: 1.79×10-15, OR: 15.8148, 95% CI: 7.15-34.99). It was also observed that HLA-Cw6 positive individuals had a more severe form of the disease, determined by a PASI score >6 (p-value: 0.0494, OR: 2.22, 95% CI: 0.96-5.15), and significant involvement of scalp psoriasis (p-value: 0.0054, OR: 13.125, 95% CI: 1.55-111.42). However, no significant association of HLA-Cw6 was seen with positive family history, nail involvement, and joint pain (arthralgia).
Conclusion: The HLA-Cw6 positivity was associated with a more severe form of disease and scalp psoriasis.
Morphological patterns, Nail involvement, Polymerase chain reaction, Psoriasis area and severity index
Psoriasis is a common, chronic, recurrent skin disease that is immune-mediated with a strong genetic component, but environmental factors like infections also play an important role in the presentation of the disease (1). Its prevalence varies from 0.44-2.8% in India. The disease has an unpredictable course and complex aetiology. Morphologically the disease presents with different clinical patterns, the commonest being plaque type. The other variants are guttate, inverse or flexural, nail psoriasis, scalp psoriasis, psoriatic arthritis, pustular and erythrodermic (2). Nail involvement in psoriasis can occur in 10-78% of patients (3). PASI score is used to calculate the extent of involvement and severity of psoriasis (4). Many psoriasis susceptibility loci have been identified on genome-based scans. Genome-wide linkage analyses have shown an association of psoriasis with a locus on chromosome 6p in which HLA-Cw6 is more likely susceptible allele in the Psoriasis Susceptibility Locus 1 (PSORS1), seen up to 50% of disease inheritability (5),(6). In a recent study, on the Indian Tamil ethnic population, HLA-Cw6 is strongly associated with psoriasis (7). Further, in Eastern India, no studies have been done on HLA-Cw6 and psoriasis regarding the disease severity and morphological pattern. Thus, the study aimed to estimate the risk of HLA-Cw6 association with psoriasis compared to the control group and to explore the association between HLA-Cw6 haplotype with the severity of psoriasis expressed as PASI score and morphological patterns.
A cross-control study was conducted from March 2014 to February 2015 at Department of Dermatology, Institute of Post-Graduate Medical Education and Research, Kolkata (West Bengal), a tertiary care centre in the eastern part of India. Total 100 patients were taken into study and those patients coming to OPD not having psoriasis were taken as control. This study was approved by Institutional Ethics Committee (IEC No. 441).
Inclusion criteria: All consecutive patients coming to Department of Dermatology Outpatient Department (OPD) and first time diagnosed clinically with psoriasis and willing to give written informed consent were included in the study.
Exclusion criteria: Patients not giving informed written consent, exclusive palmoplantar psoriasis, and psoriasis patients associated with other autoimmune diseases were excluded from the study.
Study Procedure
Detailed history, clinical examination, and PASI score and digital photographs of lesions were taken (8). Skin biopsy was taken to confirm the diagnosis in doubtful cases. A blood sample was taken from each patient for HLA-Cw6 typing by sequence-specific PCR method.
Statistical Analysis
Data analysis was done by appropriate statistical test (Chi-square test) (p-value <0.05) using R statistical software.
A total of 100 patients with psoriasis were recruited, of which 39 were female, and 61 were male. The minimum age of the patient was 8 years, and the maximum was 81 years and mean age (years) was 35.12±15.5. Out of 100 psoriasis patients, 61 were positive for HLA-Cw6, while amongst 100 control subjects, only nine were HLA-Cw6 positive. HLA-Cw6 distributions and association in psoriasis patients and control group is depicted in (Table/Fig 1).
HLA-Cw6 positive psoriasis patients had significantly associated with severe disease (PASI >6) compared to mild disease (PASI ≤6). Association of HLA-Cw6 according to PASI score is depicted in (Table/Fig 2).
A significant proportion of HLA -Cw6 positive patients had scalp involvement compared to HLA-Cw6 negative patients. However, there were no significant difference in nail involvement, arthralgia, and family history with HLA-Cw6 positive patients as compared to HLA-Cw6 negative patients. HLA-Cw6 distribution and association according to clinical involvement is depicted in (Table/Fig 3).
There were no significant associations in clinical types of psoriasis with HLA-Cw6 positive patients compared to negative patients. HLA-Cw6 distribution and association according to morphological patterns is depicted in (Table/Fig 4).
The present study included 100 patients with psoriasis attending the dermatology OPD of a tertiary care centre in the eastern part of India. It was found that a statistically significant proportion of psoriasis patients were HLA-Cw6 positive than the control group (p-value: 1.79×10-15). A study done by Singh S et al., amongst north Indian patients (sample size=75) with psoriasis showed a significant association with HLA-Cw6 positivity (9). Apart from this, other studies done by Kastelan M et al., in Croatian population (sample size=108) and Kim TG et al., in Korean population (sample size=84) also had similar findings (10),(11). This finding supports a strong association of psoriasis with HLA-Cw6 positivity in different geographical regions.
A HLA-Cw6 positive psoriasis patients showed higher PASI scores. It was found that PASI score >6 (moderate to severe) had a significant association (p-value: 0.0494) with HLA-Cw6 but not with mild disease. This study was similar to a study done by Sathishkumar D et al., in southern Indian children (sample size=108), in which a higher PASI score (>10) was significantly associated with HLA-Cw6 positivity (12). Another study among South Indian ethnic population (sample size=100) showed moderate PASI score (5-10) associated with HLA-Cw6 positivity. Similar study done by Fan X et al., among Han Chinese population in a cohort of 679 patients showed HLA-Cw6 positive patients had severe disease (PASI score >15) (13).
It was found that there were no significant differences in nail involvement with HLA-Cw6 positive patients as compared to HLA-Cw6 negative patients (p-value: 0.523757196). In a study done by Gudjónsson JE, in 369 patients with familial psoriasis, 138 patients had psoriatic nail changes but no significant association with HLA-cw6 was found. A study done by Indhumathi S et al., in 355 southern Indian Tamil psoriasis patients, 122 patients had nail involvement (p value-0.11) (14),(15).
A total of 17 patients (N=100) had a positive family history, in which 12 were positive for HLA-Cw6. It was found that there was no significant differences (p-value: 0.272105968) in family history with HLA-Cw6 positive patients as compared to HLA-Cw6 negative patients. Similarly in study done by Bahcetepe N et al., also found no significant differences in family history (16). However, another study by IIkäheimo I et al., in Omani Arab population shown HLA-Cw6 had a stronger correlation with an overall positive family history (17). This may be due to difference in geographical regions.
There was a statistically significant association seen in HLA-Cw6 positive patients with scalp involvement in comparison to HLA-Cw6 negative patients (p-value: 0.00537252). A study done in southern Indian population on childhood psoriasis by Sathishkumar D et al., showed HLA-Cw6 was associated with scalp involvement (12). There are very few studies done in Indian population to show relationship between scalp involvement in psoriasis and HLA-Cw6. These studies confirm that HLA-cw6 may link to pathogenesis of scalp psoriasis.
Ten out of 14 patients with arthralgia were positive for HLA-Cw6, suggesting no significant difference (p-value: 0.245108566) than HLA-Cw6 negative patients. A study done by Fan X et al., among Han Chinese population showed no significant difference in arthralgia with HLA-Cw6 positive patients as compared to HLA-Cw6 negative patients (p-value-0.733) (13).
Among all patients (N=100), the most common morphological type was plaque type (93), followed by guttate, erythrodermic, and pustular types. It was found that there was no significant association of HLA-Cw6 positive patients with these morphological types. Similar study results were shown by Fan X et al., and Indhumathi S et al., for generalised plaque type of psoriasis and erythrodermic psoriasis. However, in their studies, gutted type of psoriasis had a significant association with HLA-Cw6 (13),(15). This difference found in the study may be due to large sample size taken by those authors due to which study variables have increased and more clinical varieties of psoriasis were seen.
Limitation(s)
Because of the low prevalence of psoriasis, study subject was limited to 100. Demographic characteristic of the control group was not included in the study.
This study amongst 100 patients having psoriasis observed a significant association of HLA-Cw6 with the severity of disease and involvement of specific sites like the scalp. However, further study with a larger population may further improve our knowledge of psoriasis, its genetic basis, and various manifestations.
10.7860/JCDR/2021/50595.15198
Date of Submission: May 29, 2021
Date of Peer Review: Jul 03, 2021
Date of Acceptance: Jul 07, 2021
Date of Publishing: Aug 01, 2021
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jun 03, 2021
• Manual Googling: Jul 06, 2021
• iThenticate Software: Jul 19, 2021 (8%)
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