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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
Clinical, Radiological and Spirometric Analysis of Treated Tuberculosis Patients-A Cross-sectional Study
Correspondence Address :
Bhavesh M Patel,
41, Preet Bunglows, Chaani, Vadodara-391740, Gujarat, India.
E-mail: dr.bhavesh0705@gmail.com
Introduction: Post-Tuberculosis (TB) complications may involve the lungs, mediastinum, pleura, chest wall, or any combination of these structures. It can also affect the caliber of the airways which might lead to the increase in their resistance and decrease in the airflow, severely impairing the quality of life. Due to a lack of controlled trials in this population, no evidence-based recommendations for the investigation and management of post-TB complications are currently available.
Aim: To study the clinical symptoms, radiological involvement and the spirometry pattern of previously treated TB patients.
Materials and Methods: This cross-sectional study was conducted in the Department of Respiratory Medicine, Shri MP Shah Government Medical College and Guru Govind Singh Government Hospital, Jamnagar, from July 2018 to December 2019. Total 102 patients with history of TB and currently sputum negative were enrolled in the study. All patients underwent clinical examination, microbiological examination, chest radiograph, and spirometry. Data was collected from case record form and entered into MS Excel spreadsheet 2016. Data analysis was done in Statistical Package of Social Science (SPSS) software version 26.0.
Results: Out of the 102 patients, there were 66 (64.71%) males and 36 (35.29%) females. Of the study population, 13 (12.74%) was asymptomatic, 7 (6.86%) had dyspnoea, 17 (16.66%) had cough and 65 (63.72%) had both cough and dyspnoea. Spirometry analysis revealed that 26 (25.49%) were normal, 6 (5.88%) had restrictive pattern, 69 (67.64%) had obstructive pattern and 1 (0.98%) had mixed pattern. Chest radiograph revealed unilateral chest involvement in 78 patients (76.47%) and 24 patients (23.52%) had bilateral chest involvement.
Conclusion: There is high prevalence of post-TB pulmonary disability causing clinical symptoms, radiological involvement and spirometry changes and thus should be assessed early to prevent further complications.
Chest radiograph, Dyspnoea, Obstructive pattern, Pulmonary disability, Restrictive pattern, Spirometry
Tuberculosis remains a significant cause of global morbidity and mortality (1),(2). About 10 million people developed TB and 1.4 million people died from TB in 2019, with most of the cases in developing countries (1). Pulmonary Tuberculosis (PTB) can cause variable changes in pulmonary parenchyma. These changes range from pulmonary infiltrate to parenchymal lung devastating (3). One of the most devasting sequelae of TB is Tuberculosis-destroyed Lung (TDL). Decreased lung and airway volume in patients with TDL are associated with progressive lung function decline, respiratory failure and pulmonary disabilities (4). Greater lung injury has been associated with smoking, malnutrition, delayed diagnosis of TB, number of previous treatments, and a high bacillary load at the beginning of anti TB treatment (5).
On chest radiograph, even minimal scar change may lead to airflow limitation (6),(7). The changes resulting from PTB that are seen after treatment, present as Restrictive Lung Disease (RLD), Obstructive Lung Disease (OLD), or Mixed Obstructive-Restrictive Lung Disease (MORLD) (8). Ventilation impairment in lung function is usually restrictive during active PTB treatment phase. This may persist, resolve, or change to an obstructive pattern later (9),(10). TB patients have higher odds of permeant functional changes (restrictive or obstructive pattern) in comparison to patients without TB (11),(12).
Thus, this study was conducted to know the most common symptoms leading to discomfort in patients along with the radiological and spirometry analysis in these patients.
A cross-sectional study was conducted at the Department of Respiratory Medicine, MP Shah Government Medical College, and Guru Govind Singh Government Hospital, Jamnagar, from July 2018 to December 2019. The Institutional Ethics Committee approved the study vide letter number IEC/Certi/95/2018. A 102 consecutive patients who visited the Outpatient Department (OPD) during the study period, fulfilling the following criterion, were included in the study.
Inclusion criteria:
• Patients having history of (sputum positive/sputum negative) PTB who have completed the treatment (drug sensitive, multidrug resistant or extensive drug resistant).
• Patients confirmed as currently sputum negative by microbiological examination.
• Patient aged more than 18 years.
• Smoker or non smoker.
• Patients who were treatment defaulters and who had relapse of TB but were currently sputum negative.
Exclusion criteria:
• HIV positive patient.
• Pregnant female.
• Recent upper abdominal surgery.
• Ischaemic heart diseases patient.
• Kyphoscoliosis.
• Any other respiratory diseases not a sequel of TB. (e.g. bronchial asthma, chronic obstructive pulmonary diseases).
• Patient not willing to give informed consent.
Informed consent was obtained from all patients included in the study and patient information sheets in local language were provided to all patients. All patients underwent detailed history and physical examination. Patients with history and clinical features suggestive of reactivation of PTB underwent sputum microbiological assessment and if it was negative, they were enrolled in the study. Radiological assessment was carried out through Chest X-ray Postero-anterior (PA) view. Pre and postbronchodilator spirometry assessment was conducted after holding bronchodilator (if on any) for 24 hours and then analysed.
Statistical Analysis
Data was collected from case record form and entered into MS excel 2016. Data analysis was done in SPSS software version 26.0.
In the present study, the most common involved age group was among 26-49 years and males were predominantly involved. Majority of the patients were labourers and residing in rural areas. Significant number of patients were non smokers (Table/Fig 1).
Most of the patients were having cough along with dyspnoea followed by cough alone and dyspnoea. Few patients were asymptomatic (Table/Fig 2). Majority of the patients were having unilateral lung involvement in comparison to bilateral lung involvement. In the current study, fibrosis was the most common abnormality followed by bronchiectasis (Table/Fig 3).
Obstruction is the most common spirometry abnormality found followed by restrictive and mixed type. Significant number of patients was having normal spirometry (Table/Fig 4).
In smokers, 32 patients were having abnormal spirometry pattern out of 34 which is 94.11% in comparison to non smokers which is 64.71% (44 out of 68) (Table/Fig 5). In males, 54 patients were having abnormal spirometry pattern out of 66 which is 81.81% in comparison to females which is 61.11% (22 out of 36) (Table/Fig 6). In the patients having recurrent TB in the past, 22 patients were having abnormal spirometry pattern out of 37 patients, which is 59.45% in comparison to non recurrent TB cases which is 83.07% (54 out of 65) (Table/Fig 7).
Despite the fact that Post-Tubercular Obstructive Airways Diseases (post-TB OAD) has been well-documented for many years, TB patients are not routinely counselled or followed-up on for post-Tuberculous sequelae. Such patients are frequently misdiagnosed with TB on multiple occasions based on chronic cough, expectoration, or haemoptysis. Even though the exact pathophysiology of post-TB OAD is uncertain, an immunological theory has been suggested. It has also been postulated that TB annihilates lung parenchyma by up-regulating numerous proteases and dysregulating the protease control mechanism. Matrix metalloproteinase-induced pulmonary damage results in cicatricial transformation of lung tissue, and such fibrotic changes are almost certainly responsible for the associated restrictive disorder (13).
Long-term pulmonary complications and sequelae from PTB include lung fibrosis, endobronchial stenosis, bronchiectasis, aspergilloma, and chronic airway narrowing. It has also been demonstrated to be a risk factor for developing lung cancer (14). Such a sequel frequently results in complications like pulmonary hypertension, cor pulmonale, recurrent respiratory infections, and haemoptysis. These patients’ typical daily behaviours are also affected, which leads to low Quality of Life (QoL), an increased financial burden, and a negative psychological impact (15). In PTB, patients who still have pulmonary impairment after anti TB therapy, the infection is reduced, and the lung function is improved. For a small group of patients, straightforward spirometry has been used to investigate the type of pulmonary impairment. The clinical and spirometry profiles of such post-TB OAD patients were evaluated in the current study. (Table/Fig 8) shows the spirometry pattern in different studies (16),(17),(18).
In the current study, majority of the patients were having obstructive Spirometry changes 67.6% and 5.8% had restrictive changes in comparison to a study conducted by Patil S et al., 42% obstructive, 18% mixed (Symptomatic group) and 32% obstructive, 14% mixed (Asymptomatic group) (16). Such a high prevalence of the mixed pattern can be explained by extensive fibrosis co-existing with obstructive abnormality. In a study conducted by Mancuzo EV et al., showed that LSD+Lung disease present (33.3% obstructive, 10.9% restrictive, 28.2% mixed) and LSD (Lung disease absent) 20.6% obstructive, 24.5% restrictive, 8.9% mixed) (17). In the study conducted by Santra A et al., observed that 27.5% showed obstructive changes and 72.46% mixed changes (18). As in the current study, males were primarily involved in all the above-mentioned studies.
In the current study, significant number of patients was from rural area, which may be the cause of their late presentation to the healthcare facility leading to delay in their diagnosis and treatment thereby leading to high percentage of post-tubercular symptoms and sequalae. It was seen that male gender had more chance of developing post-TB pulmonary disability which may be due to more universal prevalence of smoking among the males. In this study, it was seen that smokers had more prevalence of post-TB pulmonary disease which may be due to the additive destructive effect of the smoking along with TB diseases. Since a long time, it has been documented that PTB is more common in smokers. This is most likely because nicotine inhibits Tumour Necrosis Factor-alpha (TNF-α) production by lung macrophages, making the patient more vulnerable to the development of progressive disease from latent Mycobacterium TB infection (19).
A strong association between a medical history of TB and airflow obstruction has been proved beyond doubt by a large population based, multicentre study in Latin America (PLATINO study). Such similar findings have also been seen in this study (20).
Limitation(s)
The long-term consequences were not known as the patients were not followed-up later. Hence, the effect of disease on quality of life, the progression of disease and survival rate of the patient was not known. Future studies should be done looking into these long-term effects.
This study found that patients with recurrent TB had more pulmonary disability. Early detection, treatment of PTB, and smoking cessation can significantly reduce patient morbidity and improve pulmonary function. Post-TB pulmonary disability is common, causing clinical symptoms, radiological involvement, and spirometry changes.
DOI: 10.7860/JCDR/2023/61146.17641
Date of Submission: Oct 31, 2022
Date of Peer Review: Dec 12, 2022
Date of Acceptance: Feb 20, 2023
Date of Publishing: Mar 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: Nov 11, 2022
• Manual Googling: Jan 18, 2023
• iThenticate Software: Feb 16, 2023 (20%)
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