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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
Case report
Full Version
Pulmonary Candidiasis in an Immunocompetent Patient
Correspondence Address :
Yogesh Kakde,
Raghobaji Hostel, Wardha, Maharashtra, India.
E-mail: yogeshkakde95@gmail.com
Clinically, fungi infections of the respiratory system are uncommon. The pathogen culture and the clinical characteristics are frequently used in the clinical diagnosis of fungi. Two different patterns of invasive pulmonary candidiasis have been described: primary candida bronchopneumonia and secondary pulmonary disease arising from haematogenous dissemination or rarely primary bronchopneumonia. Primary candida bronchopneumonia is limited largely to immunocompromised patients and is thought to occur by aspiration of candida into the upper respiratory tract. This is a case of a 55-year-old male who presented with the chief complaint of dyspnoea on exertion, intermittent fever, and cough associated with expectoration of 1-month duration. The fever was moderate grade and intermittent without chills, rigours or night sweats. Respiratory system examination revealed bilateral scattered course crackles in both lung fields. Chest X-ray revealed heterogeneous opacities in bilateral upper lobes and hyperinflation of the lung. Biopsy specimens from para hilar (centrilobular nodules) were obtained and stained with Haematoxylin and Eosin (H&E), periodic acid Schiff, and Gram stain. Clusters of pseudohyphae and budding yeasts were detected in the nodules, indicating candida infection. Sputum microscopy confirmed pulmonary candidiasis. The patient’s bronchoscopy was done and bronchoalveolar lavage was sent for investigations and the growth of candidiasis came positive.
Aspiration, Cough, Dyspnoea on exertion, Fungal infections, Intermittent fever
A 55-year-old male presented to the Department of Medicine in the tertiary hospital care with the chief complaint of dyspnoea on exertion, intermittent fever, and cough associated with expectoration of 1-month duration. There was no history of any hospital admission, chronic obstructive airway diseases, haemoptysis, rhinorrhoea, paroxysmal nocturnal dyspnoea, or orthopnoea. The fever was moderate grade and intermittent without chills, rigours, or night sweats. He was a former smoker who had quit smoking ten years earlier and used to smoke one pack a year. He also denied having alcohol and illicit drug use. There was no history of weight loss and no history of other co-morbid illness.
General examination revealed a body temperature of 36.6°C, oxygen saturation of 99% in room air, blood pressure of 136/76 mmHg, pulse rate of 84/min, and respiratory rate of 22/min. Respiratory system examination revealed bilateral scattered course crackles in both lung fields. Routine investigations are tabulated in (Table/Fig 1). Chest X-ray revealed heterogeneous opacities in bilateral upper lobes and hyperinflation of lungs (Table/Fig 2). High-Resolution Computed Tomography (HRCT) revealed multiple centrilobular nodules with linear branching giving tree in bud appearance diffusely involving along with patchy areas of consolidation in bilateral lung fields relatively sparing bilateral lower lobes (Table/Fig 3). Cardiovascular and per abdomen examinations were normal.
Sputum was induced with 3% normal saline nebulisation and early morning sputum was sent for 3 consecutive days for Acid-Fast Bacilli (AFB) which was negative and Cartridge Based Nucleic Acid Amplification Test (CBNAAT) was also negative. Gram staining of sputum revealed gram-positive budding yeast cell without pseudo hyphae indicating candida species growth (Table/Fig 4).
Biopsy specimens from para hilar (centrilobular nodules) of the upper lobe of the left side lung was obtained and stained with Haematoxylin and Eosin (H&E), periodic acid Schiff, and Gram stain. Clusters of pseudohyphae and budding yeasts were detected in the nodules, indicating candida infection (Table/Fig 5).
The patient was started on systemic intravenous fluconazole for 3 weeks. As he responded well, the patient was discharged on the 3rd week on oral fluconazole for 3 weeks and was asked for a follow-up in OPD after 15 days. However, the patient did not report back.
All age groups can be impacted by candidiasis. Patients with immunosuppression were more likely to acquire candidiasis than immunocompetent people. The microflora of the human body contains opportunistic infections called Candida species (1). Patients in Intensive Care Unit (ICUs) are more likely to get candida infections, which lengthen hospital stays and raise mortality rates (2). The most significant issue when candida is formed, especially in cases originating from the respiratory tract, is either colonisation or invasive pulmonary candidiasis. Since candida is a component of the microflora, it must first be distinguished from colonisation in the tissue as a whole.
Over the past two decades, invasive, opportunistic mycoses have become more common in individuals with acquired immune deficiency syndrome, neoplastic disease, advanced age, immunosuppressive therapy, premature newborns, prolonged antibiotic use, late sepsis, and in patients undergoing blood and marrow transplantation and solid organ transplantation. Immune failure caused by Candida increases vulnerability to other respiratory infections in individuals at risk for developing serious fungal infections.
The prevalence of opportunistic mycotic infections rises over time as a result of an increase in immunosuppressive illnesses. The most frequent fungus linked to infections in immunocompromised people is still Candida albicans. An uncommon illness, pulmonary candidiasis, commonly affects people who are immunosuppressed (3).
There is no pathognomonic or radiological image associated with the presence of Candida in respiratory specimens, which may be the result of contamination. A confirmation of the organism in tissues is necessary for a conclusive diagnosis. Either dispersion from the upper airways or aspiration from those airways causes pulmonary invasion. Candidiasis typically manifests as colonisation rather than infection, and risk factor includes immunosuppression, neutropenia, haematologic malignancies, long-term antibiotic usage, late sepsis, and total parenteral feeding. On chest radiograph, bilateral bronchopulmonary infiltrates are a sign of pulmonary candidiasis, which can also manifest in one of four clinicopathologic ways: a) as a primary infection that is likely brought on by aspirating bacteria from the mouth; b) as part of a systemic haematogenous infection that involves multiple organs. The infection may eventually spread outside of the lung or it may remain localised; c) the organism may build up in the airways in conjunction with pulmonary illness; and d) it may occasionally take the form of a mycetoma.
C.Albicans, a mucous membrane found as a part of the regular normal microflora in the digestive tract, is the most prevalent species of this fungus (between 9% and 80%). Additionally, this fungus is common place in hospitals, whether it is in the air or on inert surfaces like floors, roofs, and food instead of being a harmless guest in patients’ mucus who has bronchopulmonary disorders. Candida albicans has developed into a potentially dangerous fungus, which could aggravate the problems in these conditions. It was discovered that C.albicans (59%) predominated in cases of candida co-infection, followed by C.tropicalis (20%) and C.glabatra (20%) (4),(5). Pulmonary candidiasis is uncommon, although it has been linked to high mortality in immunocompromised or severely ill patients (6). Multiple cavitary lesions associated with air-space consolidation have been reported as the most prevalent chest Computed Tomography (CT) findings of pulmonary candidiasis (7).
Sputum cultures become unreliable for diagnosis as the yeast colonises the upper airway, necessitating blood culture, body cavities, and/or sterile organ locations for definite identification. Pulmonary candidiasis can show as a solitary parenchymal lung nodule without recurring infections in patients with low immunoglobulin G levels (8). Dermatitis, esophagitis, thrush, mediastinitis, vulvovaginal candidiasis, peritonitis, endocarditis, and septic arthritis, are all manifestations of candidiasis. Although nodular cavitary pneumonia is uncommon, it was detected in the index case.
In non neutropenic critically sick patients, a Candida score calculator helps to evaluate the chance of invasive candidiasis vs colonisation. In patients, severe sepsis (2 points), complete parenteral nutrition (1 point), the initial operation (1 point), and multifocal candida colonisation make up the candida score. These are the tell-tale signs of a candida infection. The index patient exhibited unifocal candida colonisation, which resulted in a score of 1. With a total score of 1, he had a 2.3% chance of developing invasive candidiasis without treatment (9).
Current diagnostics may mistake concurrent infections with several fungi for monomicrobial infections, with consequences for the use of antibiotics that may affect patient outcomes. One should determine the origin of mixed fungal infections by using molecular techniques on tissue samples. When applied to tissue samples, broad-range Polymerase Chain Reaction (PCR), sequence analysis, and Fluorescence Insitu Hybridisation (FISH) are a potent combination for determining the cause of mixed infections, including invasive fungal infections (10).
Echinocandins and azoles are the most popular antifungal medicines used to treat candida. Voriconazole is the major medication advised by the Infectious Diseases Society of America (IDSA) guidelines for treating invasive pulmonary aspergillosis, with amphotericin B, caspofungin, micafungin, and itraconazole as alternatives (11). The following antifungal medications should be used to treat Candida: fluconazole, amphotericin B, echinocandin, voriconazole, or the combination of fluconazole and amphotericin B (12).
To summarise, radiological findings such as ground-glass opacities, consolidation, miliary mottling, and microabscess cavities in such patients, pulmonary candidiasis should be considered. Although this CT result is assumed to be specific for pulmonary aspergillosis, it should also be considered in pulmonary candidiasis in individuals with risk factors. Hence, biopsy from centrilobular nodules was taken and suggestive of pulmonary candidiasis. We feel that our instance will aid in understanding and acknowledging this unusual condition’s spectrum.
DOI: 10.7860/JCDR/2023/60766.17656
Date of Submission: Oct 15, 2022
Date of Peer Review: Nov 30, 2022
Date of Acceptance: Jan 10, 2023
Date of Publishing: Apr 01, 2023
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• 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: Oct 17, 2022
• Manual Googling: Dec 06, 2022
• iThenticate Software: Jan 09, 2023 (13%)
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