|
Case reports and brief
reports are two common formats in scientific reporting. However, these
reports are often criticized for their lack of original research, isolated
observations, and superficial approach(1). We conducted a study to
determine whether a comprehensive study of case reports and brief reports
published in the journal, Indian Pediatrics give potentially useful
information. The search strategy was based on the inclusion of infectious
diseases related reports from the journal website (http:/www.
indianpediatrics.net). Reports related to non-infectious diseases,
non-infectious diseases complicated by an infection, and articles whose
full text was not accessible through internet were excluded from the
study. These search criteria yielded 43 infectious disease related
articles (out of a total of 307 articles; 157 case reports, and 150 brief
reports), consisting of 22 case reports, and 21 brief reports. These
articles were published in the journal "Indian Pediatrics" between August
1999 to March 2002. One-way ANOVA was used to compare the distribution of
infectious disease related reports during the study period, and Spearman
rank order correlation test was done to quantify association between
microbial etiology, recovery rate, and type of diagnostic test.
There was no significant
difference in the reporting of infectious disease related reports during
the study period ( P = 0.657481; one-way ANOVA). Tertiary care centers and
apex hospitals in New Delhi, Vellore, Chandigarh, and Mumbai topped the
list in infectious disease reporting (Table I). Most of the
reported cases were sporadic (76.8%), and bacterial and viral pathogens
comprised 76.7% of the reports. ELISA along with culture (27.9% each) was
found to be the commonest diagnostic method used. Case reports were
predominantly descriptive epidemiologic studies (95.5 %), whereas brief
reports were either, analytical cross sectional studies (52.4%),
analytical cohort studies (23.8%), or interventional studies (23.8%).
Single case reporting (modal value of statistical average = 1) was
commonest in case reports; in brief reports larger sample sizes (mean =
343; SD = 907; range: 1417-2157) were studied. The geographical origin of
the case(s) or the population group was rarely mentioned in the reports.
Viral diseases were more frequently associated with rapid tests like ELISA
(rs = 0.5745; one-tailed P = 0.000029, two-tailed P = 0.0000057; Spearman
test). In case reports bacterial diseases showed a significantly higher
recovery rate than other infectious diseases ( rs = 0.4303; one-tailed P =
0.022889, two-tailed P = 0.045778; Spearman test).
Table I- Results of the Study Parameters Regarding Case Reports (n=22) and Brief Reports (n=21)
Study Parameters
|
|
No. of
Case Repors
|
No. of
Brief reports
|
Total
|
Year of reporting
|
1999*
|
3/24 (12.5)
|
5/21 (23.8)
|
8/45 (17.8)
|
|
2000
|
5/62 (8.1)
|
7/56 (12.5)
|
12/118 (10.2)
|
|
2001
|
11/53 (20.8)
|
7/55 (12.8)
|
18/108 (16.7)
|
|
2002+
|
3/18 (16.7)
|
2/18 (11.1)
|
5/36 (13.9)
|
Place of reporting
|
New Delhi
|
9 (40.9)
|
8 (38.1)
|
17 (39.5)
|
|
Vellore
|
2 (9.1)
|
4 (19)
|
6 (14)
|
|
Chandigarh
|
4 (18.2)
|
0 (0)
|
4 (9.3)
|
|
Mumbai
|
0 (0)
|
3 (14.3)
|
3 (7)
|
|
Others
|
7 (31.8)
|
6 (28.6)
|
13 (30.2)
|
Reporting
institution
|
Christian Medical College,
Vellore
|
2 (9.1)
|
4 (19)
|
6 (14)
|
|
All India Institute of Medical
Sciences, New Delhi
|
2 (9.1)
|
3 (14.3)
|
5 (11.6)
|
|
University College of
Medical Sciences, New Delhi
|
2 (9.1)
|
3 (14.3)
|
5 (11.6)
|
|
Postgraduate Institute of
Medical Education &
Research, Chandigarh
|
4 (18.2)
|
0 (0)
|
4 (9.3)
|
|
Maulana Azad Medical
College, New Delhi
|
1 (4.5)
|
2 (9.5)
|
3 (7)
|
|
Others
|
11 (50)
|
9 (42.9)
|
20 (46.5)
|
Type of study
|
Descriptive epidemiology
|
21 (95.5)
|
0 (0)
|
21 (48.8)
|
|
Analytical cohort study
|
0 (0)
|
5 (23.8)
|
5 (11.6)
|
|
Analytical cross sectional
Study
|
1 (4.5)
|
11 (52.4)
|
12 (27.9)
|
|
Interventional study
|
0 (0)
|
5 (23.8)
|
5 (11.6)
|
Type of pathogen
|
Bacteria
|
9 (40.9)
|
5 (23.8)
|
14 (32.6)
|
|
Mycobacteria
|
1 (4.5)
|
2 (9.5)
|
3 (7)
|
|
Virus
|
4 (18.2)
|
12 (57.1)
|
16 (37.2)
|
|
Parasite
|
5 (22.7)
|
0 (0)
|
5 (11.6)
|
|
Fungus
|
3 (13.6)
|
0 (0)
|
3 (7)
|
|
Bacteria+Fungus
|
0(0)
|
2 (9.5)
|
2 (4.7)
|
Diagnostic
|
Culture+/-microscopy
|
9 (40.9)
|
3 (14.3)
|
12 (27.9)
|
technique
|
ELISA
|
5 (22.7)
|
7 (33.3)
|
12 (27.9)
|
|
PCR+/-ELISA
|
1 (4.5)
|
3 (14.3)
|
4 (9.3)
|
|
Others
|
7 (31.8)
|
8 (38.1)
|
15 (34.9)
|
Age
|
Range
|
1.5 months to
12 years
|
0-18 years
|
0-18 years
|
|
Average
|
4.8 years
|
NA
|
NA
|
Sex
|
Total no. of males
|
18
|
701
|
719
|
|
Total no. of females
|
8
|
611
|
619
|
Nature of the
|
Sporadic
|
22 (100)
|
11 (52.4)
|
33 (76.7)
|
disease
|
Epidemic
|
0 (0)
|
4 (19)
|
4 (9.3)
|
|
Endemic
|
0 (0)
|
6 (28.6)
|
6 (14)
|
Sample size of
|
Total
|
165
|
7208
|
7373
|
the study
|
Average*
|
1
|
343
|
171
|
Clinical
|
Recovery
|
18
|
2
|
20 (46.5)
|
Outcome
|
Death
|
2
|
0
|
2 (4.7)
|
|
Recovery + Death
|
1
|
5
|
6 (14)
|
|
Not applicable/NA
|
1
|
14
|
15 (34.9)
|
Figures within parentheses indicate percentage; * from August, 1999; + till March, 2002
Childhood morbidity and
mortality data is an important socio-economic development index, and
infectious disease of childhood is a public health problem in India. An
assessment of the reporting trend of infectious disease is important,
hence an indexed journal "Indian Pediatrics", which is also internet
accessible, was chosen. The journal reports Indian data predominantly, and
reports both infectious and non-infectious diseases. The study reveals the
emergence of rapid diagnostic techniques like ELISA, and PCR in the
diagnostic arsenal. This trend was more obvious with respect to diseases
where the causative microorganism is difficult or time consuming to
culture, such as in viral diseases, and extrapulmonary tuberculosis.
However, traditional methods like culture and microscopy continued to the
methods of choice for many diseases.
The place of reporting does
not necessarily reflect the geographic origin of the case. It was
unfortunate to note that this important demographic data was lacking in
most reports. This information is important not only for the creation of
case distribution maps, and epidemiologic studies, but also for
institution of prophylactic measures at the right place at the right time
to prevent spread and future recurrence.
It is suggested that
comprehensive study employing the database of the indexed journals may be
helpful in understanding the actual trend of infectious diseases in India.
Sanjay Bhattacharya,
Subhash Chandra Parija,
Department of Microbiology,
Jawaharlal Institute of
Postgraduate Medical Education & Research,
Pondicherry 605 006, India.
E-mail: parijasc@vsnl.com
.
|
