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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
Effect of Age and Sex on QRS Axis Deviation of Healthy Indian Population and Its Clinical Significance
Correspondence Address :
Shiveta Bansal, Assistant Professor Department of Physiology Gian Sagar Medical College, Banur, Patiala, Punjab, India. Ph – 09988221826 E-mail ID: shiveta26@rediffmail.com
Introduction: Electrocardiogram from 150 apparently healthy adults in the age group of 20–80 years, were analyzed using Schiller Cardiovit AT 1,3 channeled ECG machine to study the impact of increasing age and sex on QRS Axis deviation. The mean electrical axis was recorded in frontal plane for QRS complex using the Hexaxial Reference system.
Result: It was observed that there occurred highly significant leftward shift of QRS frontal plane axis with increase in age. This shift of QRS axis was also found on comparison among malesand females of the three groups separately. However there was no significant variation of QRS frontal plane axis with sex in any of three age groups.
Conclusion: It was concluded from the present study that age influences the prevalence of electrocardiographic variations and the diagnostic criterion for abnormality must be based upon the sound understanding of the normal electrocardiogram.
Discussion: The leftward shift of the frontal QRS axis with age was attributed to increased left ventricular wall thickness.
ECG, QRS Axis Deviation, Hexaxial Reference System, Age, Sex
The process of normal aging in the absence of disease is accompanied by a myriad of changes in body systems. Health and lifestyle factors together with the genetic make-up of an individual determine the response to these changes. In India, the absolute size of the aged population is considerable. The projected figures (for >65 years) for the year 2000 and 2010 are 8% and 9% respectively. The influence of age and sex on ECG measurements has been documented from as far back as 1961(1) .
With advancing age, degenerative changes occur in heart muscle and its conduction system. Some of the pathways of pacemaker system may develop fibrous tissue and fat deposits. The SA node loses some of its cells. Aging has been shown to be associated with significant left ventricular wall thickness .The purpose of the present study was to determine the presence and extent of sex and age differences in QRS axis deviation in an adult population.
The present study has been conducted on 150 healthy individuals (both male and female) in age group of 20–80 years. Individuals found free of any cardiovascular abnormality were taken up for the study. The ECG was recorded in supine position and fasting state. These were divided into 3 groups depending upon the age:- Group A 20–39 years = 50 Group B 40–59 years = 50 Group C 60–80 years = 50 All the subjects were interviewed in accordance with the pro forma enclosed and detailed history and clinical examination were taken. Informed consent was taken from the study participants.
Detailed History
Complete history with special emphasis on cardiovascular system such as history of pain in the chest, dyspnoea, palpitation, oedema feet were noted.
Clinical examination
Careful general physical examination was carried out, parti- cularly cardiovascular examination to exclude any cardiovascular disease.
Electrocardiogram:
Electrocardiograph Machine:A conventional 12 lead electrocardiogram was recorded on Schiller Cardiovit AT 1, 3 channeled ECG machine. The machine has four stainless steel electrodes and six precordial suction electrodes. 12 lead ECG was recorded which includes:
1. 3 bipolar limb leads- L I, L II and L III 2. 3 augmented unipolar limb leads - aVR, aVL, and aVF; 3. 6 unipolar chest leads- V1, V2, V3, V4, V5 and V6
A great care was taken to avoid the presence of any conducting material in the vicinity of electrocardiogram machine. The electrocardiogram was recorded in supine position and fasting state. The sensitivity of the machine was so adjusted that a potential difference of 1mV caused a deflection of 10 mm. As a routine the paper speed used during the procedure of recording the electrocardiogram was 25mm/sec.
Electrical Axis:The mean electrical axis was recorded in frontal plane for QRS complex. The method for determining the mean QRS axis in frontal plane was based on the Hexaxial Reference system which is formed by a combination of two triaxial reference systems, one formed by the three standard leads and the other by the three unipolar extremity leads.
Axis deviation:The normal axis lies between –30° and +110°. Within the range of normal (–30° to +110°), left axis deviation (0 to –30°) represents a normal horizontal heart position; and right axis deviation (+75° to +110°) represents a normal vertical heart position.
Statistical consideration:All the data was analyzed statistically.
(Table/Fig 1) (Table/Fig 2) represents the distribution of the study participants according to age and sex respectively.
(Table/Fig 3) shows mean and SD of QRS axis in the three groups A, B and C. The result shows that with increasing age mean QRS Frontal plane axis shifts towards left. On using ANOVA test, F value comes out to be 11.46 which shows HS inter-group difference (p <0.01). On comparing group A with B, t value is 1.46, which is NS (p>0.05), A with C t value is 4.17 which is HS (p<0.01) and B with C the difference is again HS (p<0.01), with t value of 3.24.
(Table/Fig 4) shows mean and SD of QRS axis in males of the three groups A, B and C. The result shows that with increasing age mean QRS Frontal plane axis shifts towards left. On using ANOVA test, F value comes out to be 6.94 which shows HS inter-group difference among males (p <0.01). On comparing group A with B, t value is 1.27 which is NS (p>0.05), A with C t value is 3.58 which is HS (p<0.01) and B with C the difference is S (p<0.05), with t value of 2.20.
(Table/Fig 5) shows mean and SD of QRS frontal plane axis in females of the three groups A, B and C. The result shows that with increasing age, mean QRS frontal plane axis shifts towards left. On usingANOVA test, F value comes out to be 6.92 which shows HS intergroup difference among females (p <0.01). On comparing group A with B, t value is 0.32 which is NS (p>0.05), A with C t value is 2.62 which is S (p<0.05) and B with C t value is 2.59 which is again S (p<0.05).
(Table/Fig 6) shows comparison of QRS Frontal plane axis between males and females of the three groups. On comparing males and females of groups A, B and C, statistical analysis shows result to be NS (p >0.05) with t value of 1.73, 0.87 and 1.49 respectively.
In this study, 150 healthy individuals (both male and female) in age group of 20–80 years were physiologically analyzed on the basis of QRS axis deviation. Changes in QRS frontal plane axis with age and sex were noted and statistically analyzed. The conclusion of the present study was compared with those of previous studies and results were drawn.
Ewy GA (1979)(2) has conducted similar studies on different ethnic groups. He concluded that the incidence of left axis deviation in the Indian schoolchildren is more than ten times the incidence reported in other populations of normal children of comparable age.
Bressan et al (1998) (3) and Xie et al (2000)(4) have also reported similar results of leftward shift of QRS frontal plane axis.
Assantachai et al (2002) (5) concluded that the most common electrocardiographic abnormality in normal older men was left axis deviation and was found consistently more often than in older women.
The deviation of heart electrical axis to a more left position with increasing age was also supported in studies by Varlamova and Evdokimov (2003) (6) Wu et al (2003),(7) Devkota et al (2006)(8) and Chermnykh and Loginova (2006)(9).
Surawicz B (2009) (10) concluded that the mean frontal plane electrical axis, determined by the vector of the maximal (dominant) QRS deflection, depends on age and body habitus . It shifts to the left with increasing age.
The leftward shift of the frontal QRS axis with age is attributed to increased left ventricular wall thickness which is due to (i) decreased number of myocytes (due to necrosis and apoptosis) but increased left ventricular myocyte size,(ii) altered growth factor regulation, (iii) focal collagen deposition.
In the present study, it was observed that there occurred highly significant leftward shift of QRS frontal plane axis with increase in age. This shift of QRS axis was also found on comparison among males and females of the three groups separately. However there was no significant variation of QRS frontal plane axis with sex in any of three age groups.
It was concluded from the present study that age influences the prevalence of electrocardiographic variations and the diagnostic criterion for abnormality must be based upon the sound understanding of the normal electrocardiogram.
The authors are thankful to the Department of Physiology, Government Medical College, Patiala, Punjab for providing the requisite infrastructure for the study.
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