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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
Influence of height on the nerve conduction study parameters of the peripheral nerves
Correspondence Address :
Dr. Dilip Thakur, Assistant Professor, Dept of Physiology, B. P. Koirala
Institute of Health Sciences, Ghopa Camp, Dharan.
Email: dilip7bp@gmail.com, Phone: 025-525555-Ext 2471 (Off);
3060 (Res); Cell- 9842037531
BACKGROUND: Nerve conduction studies (NCS) which assess peripheral nerve functions and their parameters, are known to vary with anthropometric measurements.
OBJECTIVE: To study the effect of height on the NCS variables in the peripheral nerves of the limbs.
SETTINGS AND DESIGNS: Department of Physiology, normative.
METHODS AND MATERIAL: This study was done on 34 (age: 31.24±11.57 years) consenting, healthy adults of either sex. The anthropometric factors (height, weight and BMI); the compound muscle action potential (CMAP) and the sensory nerve action potential (SNAP) were recorded by using standard techniques.
STATISTICAL ANALYSIS: The correlation of height with the NCS variables was analyzed by using the Pearson’s correlation test.
RESULTS: After the adjustment of other anthropometric factors, height (158.5±10.21cm) showed a positive correlation with the CMAP duration of all the motor nerves: right median (r=0.734, p<0.001), left median (r=0.422, p<0.05), right ulnar (r=0.561, p<0.01), left ulnar (r=0.661, p<0.001), right tibial (r=0.372, p<0.05) Thakur D, Jha S, Pandey NK, Jha CB, Bajaj BK, Paudel BH and the left tibial (r=0.353, p<0.05). The CMAP amplitudes and the latencies were also positively correlated, with the exception of the ulnar and the right radial nerves. A positive correlation with the F- wave latencies were seen in all the nerves, except in the left common peroneal nerve. However, a negative correlation was seen with the SNAP amplitude of the right sural nerve (r= -0.442, p<0.01) and the conduction velocity of the ulnar motor nerves: right ulnar (r= -0.536, p<0.01) and left ulnar (r= -0.430, p<0.05). The SNAP duration and the conduction velocity did not show any correlation with height.
CONCLUSION: Height showed a significant correlation with the NCS parameters of the motor and few sensory nerves. Diagnostic conclusions which are made from the nerve conduction data without making corrections for the height may be invalid in patients who are taller and shorter than the average individuals. This must be also be considered while developing standard/reference normative data for different nerves.
Height, nerve conduction study (NCS), compound muscle action potential (CMAP), sensory nerve action potential (SNAP)
INTRODUCTION
Nerve conduction studies (NCS) are performed to diagnose the disorders of the peripheral nervous system (1), (2). These enable the clinicians to differentiate the two major groups of peripheral diseases: demyelination and axonal degeneration (3). These also help in localizing the site of the lesions (4), (5). NCS consist primarily of the assessment of three types of nerves: motor, sensory and mixed. Motor NCS include the assessment of the compound muscle action potential (CMAP), whereas sensory NCS include the assessment of the sensory nerve action potentials (SNAP) of the accessible peripheral nerves in the upper and lower limbs. The median, ulnar, radial, common peroneal, tibial and the sural nerves are the commonly examined nerves. The commonly measured parameters of the CMAP include latency, amplitude, duration, conduction velocity and late response, e.g., F-waves. Similarly, for SNAP, latency, amplitude and conduction velocity are routinely measured (2). These parameters are known to vary with demographic profile, anthropometric measurements such as height, BMI, etc of the population which is studied and the laboratory conditions of the test1. Many studies have been done previously to evaluate the influence of the anthropometric factors such as age, height and body mass index on the nerve velocities (6), (7), (8). However, a majority of these studies were based on the western population. Therefore, this study was designed to find the effect of height on the NCS parameters of the peripheral nerves in the upper and lower limbs among our healthy population.
OBJECTIVE :- To study the correlation of height with the NCS variables of the peripheral nerves of the upper and lower limbs.
This study was done in 34 (age: 31.24±11.57 years) healthy adults of either sex in the Neurophysiology lab of the Department of Physiology, BPKIHS, Nepal. An informed written consent was taken from the volunteers and they were screened for any history of drugs/alcohol intake or medical illness which was likely to affect the nerve conduction study parameters on the basis of clinical history and physical examination, including a detailed neurological assessment. The room temperature of the laboratory was maintained at the thermo neutral zone i.e. 26±2 degree celsius. Further, the subjects were made comfortable with the laboratory set up and conditions and were advised to relax completely during the recording. The CMAP and SNAP were recorded under standard laboratory conditions by using a Nihon Kohden machine (NM-420S; H36, Japan).
The recorded anthropometric and nerve conduction study variables (1), (2) The Anthropometric factors: age, sex, height, weight, body mass index and body surface were recorded.The Motor NCS variables: For each stimulation site, CMAP latency, amplitude, duration, conduction velocity and F-waves of the median, ulnar, radial, common peroneal and the tibial nerves were recorded.
The Sensory NCS variables:
For each stimulation site, SNAP latency, duration, amplitude, and the conduction velocity of the median, ulnar, radial and the sural nerves were recorded.
The recording procedure :
1. The motor nerve conduction study variables (1), (2) For the motor nerve conduction studies, the stimulator with water soaked felt tips, was placed on the skin overlying the nerve at two or more sites (Table/Fig 1).The recording and the reference electrode were placed by using a belly tendon montage. The stimulation of the nerve which was being studied was accomplished by using a brief burst of direct electric current. The gain was set at 2-5 mV per division. The stimulation duration was in the range of 50-300 micro seconds and the amount of current never exceeded more then 50 mA because that was its upper limit which was available in the machine. The current of the stimulator was initially set to zero and it was then gradually increased, with successive stimuli. A CMAP appeared, that grew larger with the increasing stimulus strength. The current was increased to a point when the CMAP no longer increased in size and from that point the current was increased by another 20% to ensure the supra-maximal stimulation.
2. The sensory nerve conduction study variables
(1), (2) In the sensory nerve conduction studies, the orthodromic method of stimulation was used to record the SNAP of the median, ulnar, and the radial nerves (Table/Fig 2).The gain was set at 10-20 mV per division. A stimulating or recording electrode was placed on a purely sensory portion of the nerve. The ring electrodes were used to stimulate the digital nerve. An electrical pulse of either 100 or 200 micro seconds of duration was used and most of the nerves required a current in the range of 16 to 30 mA to achieve the supra-maximal stimulation. The current was slowly increased from a base line of 0 mA, usually by 3-5 mA at a time, until the recorded sensory nerve potential was maximized.
ETHICAL APPROVAL
This study was approved by the ethical review committee of the B. P. Koirala Institute of Health Sciences, Ghopa Camp, Dharan.
STATISTICAL ANALYSIS
The data which were collected were first entered into a Microsoft Excel sheet and were then statistically analyzed by using the SPSS 10.0 version. A Pearson’s correlation test was applied to find the correlation of height with the NCS variables, while adjusting for other parameters. A significant difference was considered at p values which were less than 0.05 and it was indicated at appropriate places, if it was present in any of the parameters.
The Anthropometric variables (Table/Fig 3):The average age, height and BMI were 31.24± 11.57 (yrs), 158.5± 10.21 (cm) and 21.8± 2.11 (Kg/m2) respectively. 2. The Motor NCS variables (Table/Fig 4):Height showed a significant positive correlation with the CMAP duration of all the motor nerves: right median (r=0.734, p<0.001), left median (r=0.422, p<0.05), right ulnar (r=0.561, p<0.01), left ulnar (r=0.661, p<0.001), right tibial (r=0.372, p<0.05) and left tibial (r=0.353, p<0.05). The CMAP amplitudes and the latencies of the motor nerves were also positively correlated, with the exception of the ulnar and the right radial nerves. A positive correlation with the F- wave latencies were seen in all the nerves, except in the left common peroneal nerve. However, a negative correlation was seen with the CMAP conduction velocity of the ulnar motor nerves: the right ulnar (r= -0.536, p<0.01) and the left ulnar (r= -0.430, p<0.05). 3. The Sensory NCS variables (Table/Fig 5):The SNAP amplitudes of the right sural (r= -0.442, p<0.01) nerve showed a negative correlation with height. Also, the SNAP latencies of the right radial and the sural nerves were positively correlated with height. But, the SNAP duration and the conduction velocity did not show any correlation with height.
This study aimed to investigate the effect of height on the NCS variables in the healthy adults of our population. We found a positive correlation between height and the CMAP amplitudes in most of the motor nerves, except in the bilateral ulnar and the left radial nerves. However, a negative correlation was seen with the SNAP amplitudes of the right sural sensory nerve, which was similar to that which was seen in a previous report (7). A negative correlation between the distal fiber diameter and height may best explain the decreased SNAP amplitude of the sural nerve. Hennessey WJ et al and Kokotis P et al also reported height to be negatively associated with the sensory amplitude (9), (21). Contrary to the reports of our study, Stetson DS found height to be negatively associated with the sensory amplitudes of the median and the ulnar nerves (7). Height showed a positive correlation with the CMAP duration in all of the motor nerves, but it did not show any correlation with the SNAP duration of the sensory nerves. It showed a positive correlation with the CMAP latencies of most of the motor nerves, except the right radial nerve. The SNAP latencies of the right radial and the sural sensory nerves showed a positive correlation with height. Hennessey WJ et al and Stetson DS et al reported height to be positively associated with the sensory latencies (7),(8), (9). As in our study, S. Saeed et al in their study, found an increase in the latency of the sural sensory nerve with increasing height (10). Rivner MH et al found that height was positively correlated with the latencies of the sural, peroneal, tibial, and the median nerves which were studied, which was similar to that which was found in our study (11). It showed a negative correlation with the conduction velocities of the bilateral ulnar motor and the left median sensory nerves. Takano K et al and Gutjahr L et al supported the possibility of an inverse correlation of the conduction velocity of the ulnar nerve with height (12),(13)(14)(15)(16) (17). But, Wagman IH et al, Soudman R et al, Hyllienmark L, and Kato M et al did not find any correlation between height and the conduction velocity of the ulnar nerve (18)(19)(20), (22). Conversely, no correlation was seen with the lower limb nerves, which was contradictory to the previous reports of a negative correlation with them (11), (19),(21)(22)(23)(24)(25)(26)(27) (28)(29)(30). This may be due to the small sample size of our study. However, Awang MS et al’s findings showed an absence of correlation in the median and the sural nerves, which was similar to that which was found in our study (31). Rivner MH et al and Soudman R et al also found that the median conduction velocity was not correlated with height (11), (19). Our results showed a substantial positive correlation between height and the F-wave latencies of all the motor nerves, except the left common peroneal nerves (23)(24)(25)(26)(27). Logically, taller subjects have a longer conduction time of late response, because of a longer conduction distance. Peioglou HS et al and Lin KP et al found a strong correlation between the F latencies and height (13), (14). Likewise, in the study which was done by Puksa L et al and Toyokura M et al, the minimal latency of the F-wave study was found to increase with height in studies on the upper and lower limbs (15), (16). In summary, this study shows that anthropometric factors such as height influence the nerve conduction study parameters of both the motor and the sensory nerves. Diagnostic conclusions which are made from the nerve conduction data without making corrections for height may be invalid in patients who are taller and shorter than average individuals. This study has many similarities and some dissimilarities with the earlier reported NCS variables. The probable reasons could be the true difference among the populations and the small sample size. A study with a larger sample size will certainly add more strength. Nevertheless, this study may be used as a preliminary working reference while reporting the clinical NCS findings and for further research in this field. In this way, this study has a place of significance.
Height showed a significant correlation with the nerve conduction parameters of most of the motor nerves and a few sensory nerves. Diagnostic conclusions which were made from the nerve conduction data without making corrections for height may be invalid in patients who are taller and shorter than average individuals. This must be also considered while developing standard/reference normative data for different nerves.
I will like to thank Mr. Shyam Sundar Chaudhary (Technician), Mrs. Shova Devi Mahato (Peon) and Mr. Aaitaman Limbu (Peon) of the Department of Physiology, BPKIHS, Dharan, Nepal, for their help while performing the study. I would also like to thank my wife Sarita Sharma Thakur and daughter Aarohi Thakur for their patience and support during the manuscript preparation.
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