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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
A study on the Utility of Nerve Conduction Studies in Type 2 Diabetes Mellitus
Correspondence Address :
Kanavi Roopa Shekharappa
Assistant Professor, Department of Physiology
Sri Rajarajeshwari Medical College
Bangalore- 560026, Karnataka, India.
Mobile: 09844414103
Email ID: roopa.tejaswi@gmail.com
Back ground and Objectives: Neuropathy is one of the common complications of diabetes, in which the patient’s quality of life is compromised. Nerve conduction studies (NCS) are not commonly employed to detect the neuropathy. The present study was undertaken to find out the utility of NCS as early indicator of neuropathy in diabetic patients.
Methods: 45 diabetes mellitus patients with normal HbA1c levels and 45 diabetes mellitus patients with elevated HbA1c levels were selected, making it a total of 90 diabetes mellitus patients. 45 non-diabetic, healthy subjects were chosen as acontrol group. The nerve conduction velocity was tested in all the diabetic subjects and the healthy controls.
Results: The analysis showed that the nerve conduction velocity progressively decreased from the controls (49.0 ± 3.9) to the diabetics with a good glycaemic control (47.2 ± 2.8), to the diabetics with a poor glycaemic control (45.3 ± 3.1).
Interpretation and Conclusion: There is a progressive neuronal involvement in the diabetic process which is accelerated by poor glycaemic control. Therefore, nerve conduction studies can be employed for testing and for the early indication of neuropathy in diabetic patients.
Nerve Conduction Velocity, Hba1c, Diabetes Mellitus
Diabetes mellitus, the most common endocrine disorder is characterized by metabolic abnormalities and in the long run with micro and macro vascular complications that cause significant morbidity and mortality (1). Diabetic neuropathy (DN) is one of the most commonly occurring microvascular complications accounting for 28% of all the complications in diabetics (2). It is a progressive process that has a long asymptomatic stage (3). It is important to identify neuropathy in the asymptomatic stages as the disease process progresses to the diabetic foot, a highly morbid condition that arises from the infection and the ulceration of the foot, finally leading to amputation (4). Early identification and glycaemic control are the key factors for preventing Dm. The American Academy of Neurology recommends at least one of the five criteria for diagnosing Dm: Symptoms, Signs, Electrodiagnostic Tests, Quantitative Sensory\tests and Autonomic testing (5). Practically, electrodiagnostic tests are less utilized for the diagnosis or for the follow-up of Dm. Nerve conduction studies (NCS) are electrodiagnostic tests which are used to evaluate the ability of the electrical conduction of the motor and the sensory nerves. Also, it is known that poor glycaemic control is responsible for microvasular complications (6). Glycated haemoglobin (HbA1c) has not only been established as a marker of glycaemic control but it also indicates the risk of developing small vessel complications (7). Therefore, we intended to correlate NCS with HbA1c to establish the role of NCS in diabetes mellitus, so that it can help in identifying the asymptomatic stage of DN and so that preventive measures can be instituted.
This study was undertaken in the Department of Physiology, JJM Medical College, Davangere, after following the approval from the research andethical committees. Type 2 diabetic patients attending the OPD of the JJM Medical Teaching Hospital were selected after obtaining their consent. Male, right handed patients with established type 2 diabetes of 5 to 10 years duration and those who were on treatment were tested for glycated haemoglobin (HbA1c) levels. Based on the HbA1c levels, 45 diabetic patients with HbA1c levels of <7.0 and 45 patients with HbA1c levels of >7.0 were selected and grouped into group 1 and group 2 categories respectively. Forty five age matched male, right handed volunteers, who were non diabetics and healthy were selected as controls and were grouped as group 3. The nerve conduction velocity was studied for the ulnar nerve of the right hand in all the 135 individuals. The neurophysiological measurements were performed in a warm room, with the participants in a sitting position, with their forearms partially flexed. Nerve conduction velocity measurements were made by using an electromyograph (INCO Ambala). The surface was brass plated, stimulating electrodes were placed at 5 cm below the medial epicondyle and at 5 cm above the medial epicondyle and the recording electrodes were placed over the abductor digiti minimi (ADM) muscle on the ulnar side of the hand i.e between the fifth metacarpophalangeal joint and the pisiform bone. The compound muscle action potentials (CMAPs) were evoked by the electrical stimulation (0.1 ms duration, constant current pulse) of the ulnar nerve, starting with a minimum and progressing to the maximum intensity of the stimuli. Latency, amplitude and nerve conduction velocity were assessed. The data was summarized to test the difference in the mean values between the groups 1, 2 and 3 by using the Student’s ‘t’ test; p values < 0.05 were taken as the level of significance. Further, Pearson’s correlation was used to correlate between the different parameters. The HbA1c levels were determined by the borate affinity assay (NycoCard, AXIS-SHIELD PoC AS, Norway).
The study included 45 controls and 90 diabetics. Both the cases and the controls were aged between 40 to 60 years. The results are shown in the [Tables/Figs 1 and 2]. (Table/Fig 1) shows the Mean ± SD of HbA1c, nerve conduction velocity (NCV), total latency and amplitude in groups 1, 2 and 3. The nerve conduction velocity showed a progressive decrease with the HbA1c levels (49.0 ± 3.9, 47.2 ± 2.8 and 45.3 ± 3.1 in controls, in diabetics with normal HbA1c levels and in diabetics with raised HbA1c levels respectively). Total latency showed a significant increase with poor glycaemic control in the diabetics. (Table/Fig 2) shows the Pearson’s correlation between the parameters. There was an inverse correlation between HbA1c and the nerve conduction velocity and a significant positive correlation with latency.
Diabetic neuropathy is a common complication of diabetes mellitus with severe morbidity, compromising the quality of life. An intensive treatment of neuropathy at the sub clinical level decreases the risk of neuropathy (8). Therefore, there is a need of methods to identify the at-risk diabetic patients for neuropathy. Nerve conduction studies are one of the important methods for assessing nerve functions in DN. In this study, it was observed that the nerve conduction velocity progressively decreased from the controls (49.0 ± 3.9) to the diabetics with good glycaemic control (47.2 ± 2.8), to the diabetics with poor glycaemic control (45.3 ± 3.1). These findings are in accordance with those of previous researchers (9). Bansal et al (2006) have suggested that the slowing of NCV indicates the ongoing damage to the myelin sheaths and they are also of the opinion that the amplitude decreases with the rising HbA1c levels, thus suggesting the onset of axonopathy (10). Therefore, the monitoring of diabetic patients with NCS may help in predicting the onset of DN. Since this was a cross sectional study, followup studies and interventional studies are required to emphasize the importance of the NCV estimation. Since the underlying inflammation was the cause for establishing the diabetes and its complications, this study would have been strengthened if it had correlated with one of the inflammatory markers like hsCRP.
In conclusion, the estimation of both NCV and the HbA1c levels in diabetics is helpful in identifying the risk category for DN, which is one of the main causes for severe morbidity among the diabetes mellitus patients.
The values are expressed as their Mean ± SD HS – Highly significant (p<0.001) S – Significant (p<0.05) NS – Not significant (p>0.05)
r = Pearson’s correlation co-efficient. HS – Highly significant (p<0.001) S – Significant (p<0.05) NS – Not significant (p>0.05)
The authors acknowledge the support and encouragement from the Department of Physiology, JJM Medical College, Davangere.
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