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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
Prevalence of Gastrointestinal Sequelae among Previously Hospitalised Patients due to COVID-19 and its Association with Computed Tomography Chest Severity: A Cross-sectional Study
Correspondence Address :
Dr. Sri Vengadesh Gopal,
Plot No. 23, Third Cross, VM Garden, 100 Feet Road, Shanmugapuram, Puducherry-605009, India.
E-mail: srivengadesh@gmail.com
Introduction: Coronavirus Disease 2019 (COVID-19) is a highly infectious disease primarily characterised by respiratory symptoms. While respiratory symptoms initially predominated during the pandemic, there has been an increase in Gastrointestinal (GI) manifestations in the later phase. Moreover, reports have highlighted the presence of chronic GI symptoms following COVID-19 infection.
Aim: To determine the prevalence of GI sequelae after COVID-19 hospitalisation and its association with Computed Tomography (CT) chest severity scores.
Materials and Methods: The present cross-sectional study was conducted at a COVID-19 designated tertiary care hospital, Indira Gandhi Medical College and Research Institute, Puducherry, India, from April 2022 to December 2022. Patients admitted with COVID-19 illness between January 2021 and June 2021 were included in the study. Socio-demographic details, CT chest severity scores, and chronic GI symptoms (nausea, vomiting, diarrhoea, abdominal pain, etc.) were collected from patients’ medical records and through telephonic interviews. The data were analysed using Statistical Package for Social Sciences (SPSS) version 26.0 Qualitative variables were expressed as frequencies and percentages. The association of CT severity with GI symptoms was assessed using the Chi-square test, with a p-value of <0.05 considered significant.
Results: A total of 1,903 patients who met the inclusion criteria were included in the study. Among the participants, 1142 (60%) were males and 761 (40%) were females. The majority of patients belonged to the age group of 41-60 years, followed by 21-40 years. The mean age of the patients was 48.88±1.72 years. The prevalence of chronic GI symptoms was observed in 26% of patients, with 36.6% experiencing abdominal pain and 19.6% having gastroesophageal reflux. Diarrhoea was reported by 15.8% of patients. Patients with severe CT severity scores showed a lower prevalence of GI symptoms.
Conclusion: Chronic GI symptoms were observed in nearly one-fourth of the patients hospitalised for COVID-19. Interestingly, patients with severe CT chest severity scores exhibited a lower prevalence of GI symptoms. Further experimental studies are needed to understand the pathogenesis of GI symptoms and their association with CT severity, which could contribute to the development of effective treatment strategies.
Coronavirus, Infection, Pandemic, Tomography
An outbreak of pneumonia initially originated in Wuhan, Hubei province of China had quickly spread to other parts of the world in 2020, leading to the emergence of COVID-19 (1). The World Health Organisation (WHO) declared this outbreak as a pandemic in March 2020, causing significant disruptions to global health and the economy (2). While respiratory symptoms are the hallmark of COVID-19 illness, GI symptoms such as diarrhoea, anorexia, abdominal pain, and vomiting have also been reported. The presence of abundant Angiotensin Converting Enzyme-2 (ACE-2) receptors in the intestines, which facilitate viral entry into intestinal cells, could explain the occurrence of GI symptoms in COVID-19 patients (3). Studies have also indicated that COVID-19 can impact the gut microbiota, leading to GI symptoms (4),(5),(6). Specifically, COVID-19 patients have shown a lower abundance of anti-inflammatory bacteria and an increase in opportunistic pathogens in their gut microbiomes, which may contribute to GI symptoms (5),(6). Furthermore, some patients continue to experience these GI symptoms as chronic sequelae even after recovering from COVID-19 illness (7). Therefore, this study was conducted to assess the prevalence of GI sequelae following COVID-19 hospitalisation and its association with CT chest severity scores in the South Indian population.
This cross-sectional study was conducted at Indira Gandhi Medical College and Research Institute, a COVID-19 designated tertiary care hospital in Puducherry, India, from April 2022 to December 2022. Approval for the study was obtained from the institute’s research and ethics committee (IEC No.370/IEC-33/IGMC&RI/PP-04/2022). Demographic data, presenting symptoms, and CT chest severity scores were collected from patient records in the medical records department The study included patients admitted with COVID-19 illness between January 2021 and June 2021.
Inclusion criteria: Patients who were tested positive for COVID-19 through Reverse Transcription Polymerase Chain Reaction (RT-PCR) and presented with fever, respiratory symptoms, or GI symptoms were included in the study.
Exclusion criteria: Patients with known digestive diseases such as gastroesophageal reflux disease or irritable bowel syndrome, those admitted for observation for less than 24 hours, and pregnant women were excluded from the study.
CT chest severity scores were determined based on the percentage of lung lobe involvement. The scores were classified as follows: Score-1 (<5% area involved), Score-2 (5-25% area involved), Score-3 (25-50% area involved), Score-4 (50-75% area involved), and Score-5 (>75% area involved), with a total score of 25. Scores less than 8 were considered mild, 9-15 as moderate, and greater than 15 as severe (8).
Patients included in the study were contacted via phone, and a detailed history of GI symptoms was obtained. With patients’ permission, the conversations were recorded over the phone and considered as informed consent for the study. Some patients were assessed during their follow-up visits to the hospital. GI symptoms persisting for more than 30 days after infection were classified as GI sequelae (9). Socio-demographic details (gender, age group), CT severity scores, and gastrointestinal symptoms such as nausea, vomiting, diarrhoea, and abdominal pain were recorded.
Statistical Analysis
The collected data were analysed using descriptive and inferential statistics with the help of SPSS version 26. Qualitative variables were presented as frequencies and percentages. The association between CT severity and GI symptoms was assessed using the Chi-square test. A p-value <0.05 was considered statistically significant.
A total of 1,903 patients who met the inclusion criteria were included in the study. Among the participants, 1142 (60%) were males and 761 (40%) were females. The majority of patients 715 (37.6%) were in the age group of 41-60 years, followed by 21-40 years 613 (32.2%) (Table/Fig 1). The mean age of the patients was 48.88±1.72 years.
Regarding CT chest severity scores, 30% of patients had a normal chest CT scan, while 15.7% had a severe CT severity score (Table/Fig 2).
Gastrointestinal symptoms were observed in 495 (26%) patients. Among the various GI symptoms, 36.6% experienced abdominal pain, followed by 19.6% with GI reflux, and 15.8% with diarrhoea (Table/Fig 3).
Interestingly, 28.8% of patients with a normal CT chest developed GI symptoms. For patients with mild CT severity scores, 25.6% had GI symptoms, and for patients with moderate CT severity scores, 28% had GI symptoms. However, only 18% of patients with severe CT severity scores developed GI symptoms. This finding was statistically significant (Table/Fig 4).
COVID-19 viral infection manifests as fever, dry cough, dyspnoea, headache, and weakness (10). While respiratory symptoms are common, some patients also experience GI symptoms. Recent research articles on COVID-19 have shown that the Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) virus RNA can be detected in stool specimens and rectal swabs (11),(12). Patients with diarrhoea have a higher proportion of virus RNA in their stool compared to those without diarrhoea. The elimination of SARS-CoV-2 from stool takes longer than elimination from the nose and throat (13), leading to concerns about GI infections and the possibility of faecal-oral transmission.
SARS-CoV-2 can directly or indirectly affect the digestive system by causing an inflammatory response. The ACE-2 receptor, used by the virus for entry, is highly expressed in GI epithelial cells such as the ileum, duodenum, caecum, and colon (14). Studies have shown a decrease in anti-inflammatory bacteria and an enrichment of opportunistic pathogens in the gut microbiome of COVID-19 patients, which persists even after recovery (5). Furthermore, opportunistic fungal pathogens have been observed in the faeces of COVID-19 patients during hospitalisation and recovery (6). Alterations in the gut microbiota and the expression of ACE-2 receptors in intestinal cells may contribute to GI symptoms in COVID-19 patients (4).
Extrapulmonary symptoms, including GI symptoms, can mislead physicians, as they may appear before respiratory symptoms. These symptoms can also persist as chronic conditions after recovery from COVID-19 in some patients. GI symptoms have been reported as the initial manifestation of COVID-19, even before fever and respiratory symptoms (15). The prevalence of GI symptoms varies across studies, with some reporting low prevalence, while others report higher rates ranging from 30-50% (16),(17),(18),(19),(20),(21).
Among the GI symptoms, diarrhoea and anorexia have been commonly reported, while abdominal pain is less prevalent (22),(23),(24),(25),(26),(27). The severity of GI symptoms does not necessarily correlate with the severity of COVID-19 illness (3). However, some studies suggest a higher proportion of GI symptoms in severe cases (25),(28). In present study, patients with severe COVID-19 illness had a lower prevalence of GI symptoms, indicating less involvement of the GI tract compared to the chest.
Limitation(s)
The main limitation of the study design was that the information obtained through telephonic conversation might not be as accurate compared to in-person interviews. Another limitation of the study was the inability to determine the reason for the lower prevalence of GI symptoms in patients with a severe CT chest severity score.
Chronic GI symptoms were observed in nearly a quarter of patients who were hospitalised for COVID-19. Patients with a severe CT chest severity score exhibited a lower prevalence of GI symptoms after recovering from COVID-19 illness. Further epidemiological studies with a large sample size are recommended to confirm present study findings. Additionally, experimental and animal studies should be conducted to gain a better understanding of these extrapulmonary symptoms of COVID-19. This will aid in the development of new guidelines for managing GI symptoms in COVID-19 patients.
DOI: 10.7860/JCDR/2023/66018.18852
Date of Submission: Jun 14, 2023
Date of Peer Review: Sep 06, 2023
Date of Acceptance: Oct 18, 2023
Date of Publishing: Dec 01, 2023
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. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jun 15, 2023
• Manual Googling: Sep 22, 2023
• iThenticate Software: Oct 14, 2023 (6%)
ETYMOLOGY: Author Origin
EMENDATIONS: 7
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
- Index Copernicus ICV 2017: 134.54
- Academic Search Complete Database
- Directory of Open Access Journals (DOAJ)
- Embase
- EBSCOhost
- Google Scholar
- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
- Journal seek Database
- Popline (reproductive health literature)
- www.omnimedicalsearch.com