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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
Reference Value of Nasal Peak Inspiratory Flow Rate in Indian Children: A Cross-sectional Study
Correspondence Address :
Mousumi Das,
Skyline Lakeview Complex, H Block, Flat 1B, Purbapara, Laskarpur,
Kolkata-700153, West Bengal, India.
E-mail: mousumids99@gmail.com
Introduction: Peak Nasal Inspiratory Flow (PNIF) measurement is a basic, convenient, easy to use and low cost method of determining the nasal airway patency. However, normative data for paediatric population is scarce and not available for Indian children aged 6 to 12 years.
Aim: To establish reference value of PNIF in Indian children aged 6 to 12 years of age.
Materials and Methods: A descriptive cross-sectional study was conducted between July 2012 and June 2013 in the Himalayan range of east Sikkim district and Sub-Himalayan Terai region of Darjeeling district of West Bengal. Total 1001 children aged 6 to 12 years were selected from 16 schools by simple random sampling. Of these 1001 children, 784 children were enrolled in the study after taking into account inclusion and exclusion criteria. Repeated PNIF measurements were taken from these 784 children. Mean PNIF value was calculated. The effect of age and height on PNIF was studied. The mean and standard deviation of Peak Inhalation Flow Rate (PIFR) are calculated and compared across groups using a one-way ANOVA test. Regression analysis was done to establish an equation of predicting PNIF level based on height for normal children. The analysis was carried out using Statistical Package for Social Sciences (SPSS) version 16 statistical software. An alpha level of 5% was chosen, which means that any p-value less than 0.05 was considered significant.
Results: Mean value of PNIF age group; 6-7 years-53.36 L/min, >7-8 years-56.79 L/min, >8-9 years-63.91 L/min, >9-10 years-69.45 L/min, >10-11years- 80.71 L/min, >11-12 years-85.69 L/min. PNIF increases with age and height. A simple formula has also been established to calculate mean PNIF at a given height. PNIF or PIFR (L/min)=-52.716+0.945×height in cm.
Conclusion: PNIF measurements are possible in children aged six years and older. Age and height also affect PNIF.
Nasal airflow, Nasal obstruction, Normal value, Peak nasal inspiratory flow, Reference range
Nasal obstruction may be related to age, body position, rhinic cycle or may be due to the presence of infection (tonsillitis, adenoiditis), tonsil or adenoid hypertrophy, nasal polyps and allergies. Rhinitis is a very common disease worldwide. Nasal obstruction is a common manifestation of rhinitis. Because it is difficult to evaluate nasal obstruction from a clinical examination, objective tests like rhinomanometry and acoustic rhinometry are frequently utilised (1),(2). These methods, however, needs complex, expensive equipment and highly skilled operators. Questionnaires are used to assess patient symptoms subjectively for diagnostic and research reasons. However, subjective and objective measurements of nasal obstruction do not always correlate properly (2). As a result, a simple objective measurement of nasal airflow could be highly helpful in determining nasal patency (3). A basic and inexpensive tool for this is the PNIF metre (3),(4),(5). PNIF has been proved to be a reliable measurement for assessing nasal airway obstruction by several authors (6),(7). The patient sniffs air via the nose and the peak flow is measured with PNIF. PNIF has been utilised as a screening tool for detecting rhinitis severity and evaluating nasal obstruction (8).
Ottaviano G et al., conducted a study using PNIF to estimate normal values for peak nasal inspiration in adult Caucasians (9). Normal values have also been discovered for paediatric and adolescent Greek and African populations (10),(11). Brazilian study established a simple formula to obtain reference values of PNIF for subjects aged from eight to 15 years (12).
The comparison of measured values with expected values obtained from published reference equations or normal value tables is used to interpret PNIF data.
However, to the best of our knowledge, there is no such reference value or equation for PNIF particular to the Indian paediatric population.
The American Thoracic Society and the European Respiratory Society have also advised researchers to disclose reference equations and reference values for healthy populations of various racial origins so that individual subject results can be compared to data from a racially similar group (13),(14). It is also recommended that the same assessment equipment and technique be used. As a result, this work was conducted to establish a PNIF reference equation for an Indian paediatric population, allowing for the quick, reliable, and low-cost assessment of nasal airway patency in individuals of similar racial backgrounds. The goal of this study was to find a PNIF reference value and a PNIF reference equation in the paediatric population.
A descriptive cross-sectional study was conducted between July 2012 and June 2013 in the Himalayan range of east Sikkim district and Sub-Himalayan Terai region of Darjeeling district of West Bengal, India. The study was approved by the Institutional Ethics Committee and written informed consent was taken from parents/caregivers of all participants included in the study. 1001 school children aged 6-12 years were recruited from 16 schools in the study area using simple random sampling method. From 15 of those schools 62 children of age 6 to 12 years were selected by simple random sampling. From one of those 16 schools 71 students of age group 6 to 12 years were selected by simple random sampling.
Sample size calculation: Sample size calculated from Cochran formula; n= z2(pq)/e2. n=sample size, z=standard error associated with the chosen level of confidence, p=standard deviation taken from previous studies (10),(12), q=1-p, e=acceptable sample error. n=1.962 (0.5)(0.5)/0.052=384. In the present study, 1001 sample size was taken for more appropriate analysis. Parents of respondents were asked to complete two questionnaires on enrollment in the study and prior to testing: ATS-DLD-78C questionnaire (15) and the MiniRQLQ test (16). These questionnaires were used to know whether they had any respiratory or nasal symptoms so that those having such problems can be excluded from the study.
Inclusion criteria: (1) no acute disease; (2) no chest malformations, congenital abnormalities or respiratory tract disease; (3) no cardiovascular or neuromuscular system disease or symptoms of allergic rhinitis for the previous 12 months; (4) no nasal blockage, or other nasal symptoms; (5) no chronic cough; (6) no previous nasal or paranasal sinus surgery; (7) no known case of asthma; and (8) somatometric parameters above the third percentile;
Exclusion criteria: Score of one or more in any column of MiniRQLQ test were excluded from the study.
Study Procedure
Peak nasal inspiratory flow was measured using an in-check peak flow metre (Clement Clarke International Ltd., Edinburgh Way, Harlow, Essex, CM20 2TT, UK). Rubber anaesthetic face masks of various sizes (Vital Signs, Totowa, New Jersey, USA) were employed; masks had to be wide enough to avoid constricting the nose yet small enough to prevent air escape under the chin.
All of the individuals were assessed while they were seated. Following the end of a full expiration, they were told to take a deep, quick, forced inspiration through the nose (and mask), keeping the mouth tight (i.e., the residual volume method). Three measurements were taken for each participant, with the highest of the three findings used to determine the PNIF. In the event that wrong technique was used, an additional recording was made. All tests were conducted (under standardised conditions) by the same, highly qualified examiner to prevent the introduction of variability due to various technicians.
Statistical Analysis
The mean and standard deviation of PIFR were calculated and compared across groups using a one way ANOVA test. Regression analysis was done to establish an equation of predicting PIFR level based on height for normal children. The analysis was carried out using SPSS version 16.0 statistical software. An alpha level of 5% was chosen, which means that any p-value less than 0.05 was considered significant.
Out of 1001 school children selected by simple random sampling, 784 children (557 males, 227 females) satisfied our inclusion criteria and were enrolled in the study. From the table, it is clearly seen that mean PIFR increases with age (Table/Fig 1). From the table, it is clearly seen that PIFR increases with height (R2=0.769) (Table/Fig 2).
The regression analysis to establish the equation for predicting PIFR level based on height in normal children is shown in (Table/Fig 3) as PIFR=-52.716+0.94×Height i.e., if Height increases by one unit PIFR will rise by 0.945 unit i.e.,=-52.716+0.945×Height.
Peak Nasal Inspiratory Flow (PNIF) has been utilised by many researchers to assess nasal patency, demonstrating its reliability (17),(18). Rhinomanometry has also been used as an appropriate and safe method of measuring nasal airway obstruction, with only minor inaccuracy; however, it is time-consuming, expensive, and difficult to transport, and accurate use requires experience (19). Therefore, a simple, reliable, inexpensive method of assessing nasal airway obstruction would be of value.
Evaluation at the same time and by the same examiner, and use of standardised assessment circumstances (e.g., normal room temperature and humidity) were used in the current investigation to control procedural factors affecting PNIF variability as much as possible. Not much study is available in literature regarding PNIF reference value in children.
Study done in South Africa revealed normative data of PNIF upto eight years of age (11). With the exception of a dip at three years, PNIF rises linearly from a mean of 30 L/min in early infancy to a mean of 80 L/min at the age of eight. With growing height, there is a fairly linear gradual increase. In present study, mean value of PNIF at eight years of age is 63.91 L/min. Present study also showed increment of PNIF with age and height. The difference in the value in PNIF may be attributed to difference in geographic location of the population as well as racial variation among the population. The racial difference may be attributed to difference in nasal dimension among races. In a study by Morgan NJ et al. concluded that race has a considerable impact on acoustic rhinometry measures and that this must be considered (20). Study done on Greek children also found continuous increase in PNIF with age (10). The PNIF readings of the current study participants increased in proportion with their height. This is consistent with prior findings that this variable has a major impact. (12). The authors discovered that subject age had an independent effect on PNIF. Blomgren K et al., on the other hand, found no evidence of a link between age and PNIF (21). The greater PNIF values reported in the older patients were most likely due to the steady rise in height that happens with age, as documented by Papachristou A et al., (10). From this study, the authors for the first time ever in literature established a simple formula for calculating normative value of PNIF in Indian children.
Limitation(s)
According to the questionnaire results, the present study subjects were not suffering from any acute or chronic cardiorespiratory disease. But investigations like spirometry, chest X-rays and electrocardiography would have provided more precise cardiorespiratory status of the participants. Moreover, lack of weight measurement parameter and effect of gender on PIFR was another limitation of the present study.
As per knowledge, this is the first study in India to establish a reference range of nasal PIFR in this paediatric age group. However, more studies are required in other parts of India to correlate the reference levels and also to detect any racial variation.
10.7860/JCDR/2021/48885.15090
Date of Submission: Feb 08, 2021
Date of Peer Review: Mar 01, 2021
Date of Acceptance: Apr 16, 2021
Date of Publishing: Jul 01, 2021
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
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