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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
Case report
Full Version
Supervised Structured Exercise Program on Adolescents with Polycystic Ovary Syndrome: Two Case Reports
Correspondence Address :
Dr. Jasobanta Sethi,
Professor and Director, Amity Institute of Physiotherapy, Amity University,
Noida-201313, Uttar Pradesh, India.
E-mail: jasobantsethi@yahoo.co.in
Healthy lifestyle intervention has been incorporated as first line of management when treating adolescents with Polycystic Ovary Syndrome (PCOS) but benefits of structured therapeutic programs with defined dosimetry on psychological parameters is poorly understood. Here, authors present two adolescent girls (15-year-old and 13-year-old) who presented with irregular menstrual cycle and polycystic ovarian morphology on ultrasonography. Both the girls were anxious and concerned about irregular menses. Both the girls had weight gain, anxiety and mild stress. Oral contraceptives were prescribed to one adolescent girl to regulate her menses. Supervised exercise program with combination of exercises and dietary counselling proved effective in managing adolescents with PCOS and improving their physiological and psychological health. Thus, clinicians must consider incorporating supervised exercise regime in managing adolescents with PCOS.
Adolescent girls, Healthy lifestyle, Irregular menstrual cycle
Case 1
A 15-year-old school going girl (age at menarche 12 years) reported with a significant weight gain of 20 kg in two years, with an increase of 6-7 kg within last six months. She complained of irregular menstrual periods during the last one year, with a gap of 45-50 days between consecutive menstrual cycles and periods lasting for five to six days. She is a classical Bharatanatyam dancer practicing for five years for 4 hours/week. She has one sibling with no known medical history, while her mother is a known case of Type II Diabetes Mellitus. On evaluation her blood pressure was 120/70 mmHg and Resting Heart Rate (RHR) ranged between 90-100 beats/min. On thyroid testing her Triiodothyronine (T3), Tetraiodothyronine (T4) and Thyroid Stimulating Hormone (TSH) levels were 83.3 ng/dL, 5.08 µg/dL and 1.01 mIU/L respectively. Her ultrasonography report indicated enlarged bilateral ovaries with multiple small follicles (5-8 mm) noted both centrally and peripherally but without any peripheral predominance of the follicle. The right ovary measured 3.1×2.1×2.8 cm with a volume of 10.1 cc, and the left ovary measured 4.6×1.8×2.2 cm with a volume of 10.2 cc (Table/Fig 1). Her weight was 72 kg, Body Mass Index (BMI)-27.169 kg/m2, waist circumference-34 inches and hip circumference-39 inches. Her depression, anxiety and stress scores were 8, 18 and 14, respectively on Depression Anxiety Stress Scale (DASS)-21 scale (1). She was not prescribed with any medications by her gynaecologist, but was referred for physiotherapy. The case was discussed with the parents and as per the consent of parents, patient was counselled to follow first line of management i.e., lifestyle management.
A three month structured exercise program was administered three days/week which included warm up for five minutes, followed by progressive resistance training protocol for major muscle groups using thera band. After resistance training, aerobic workout was performed starting on a low step height (Table/Fig 2) achieving 65-75% of HR max and progressed by increasing height as well as duration followed by five minutes of cool down. Additionally, the patient was encouraged to go for walk for at least half an hour on remaining four days of the week.
After three months protocol, the patient’s body weight and BMI reduced to 68 kg and 24.528 kg/m2 respectively. Hip and waist circumference, Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) remained the same. Her VO2 max (maximum rate of oxygen consumption measured during incremental exercise) improved from 32.46 mL/kg/min to 34.24 mL/kg/min. Her depression, anxiety and stress scores reduced to 6, 6 and 12, respectively on DASS-21 scale. Weight was a matter of concern even after three months protocol. Although, the time gap between consecutive menstrual cycle length reduced to 40 days or even lesser. Further follow-up of the patient could not be continued as she developed vertigo and dizziness and was under treatment for vertigo.
Case 2
Another patient was a 13-year-old school going girl who presented with complaint of prolonged bleeding per vagina lasting for 10-15 days continuously in a month. She reported a weight gain of 8 kg in one year. She has two siblings one elder sister and another younger brother. Her elder sister was also suffering from PCOS and was on medications for the same. This 13-year-old girl was a known case of PCOS. Her BP was 120/80 mmHg and RHR ranged between 60-75 beats/min. Her weight was 55 kg, BMI-22.357 kg/m2, waist circumference-32 inches and hip circumference-36 inches. Her TSH level was 4.85 mIU/L and ultrasonography report indicated polycystic ovaries. Her depression, anxiety and stress scores were 4, 8 and 10, respectively on DASS-21 scale. She was prescribed meprate (10 mg TDS for 4 days) (a progestin, an oral contraceptive pill) then twice daily for 21 days to improve her menstrual cyclicity. Patient took the above medication for one month. Syrup shelcal twice daily for one month was prescribed. Simultaneously, she was recommended to be physically active and control carbohydrate and fat intake with more of proteins in her diet to regulate her hormonal profile. She was also administered the same structured exercise program for a duration of three months.
After three months protocol her weight and BMI increased to 61.6 kg and 25.04 kg/m2 respectively. Hip and waist circumference, SBP and DBP remained the same. Her predicted VO2 max was 40.31 mL/kg/min but it reduced slightly to 39.04 mL/kg/min which may be due to increase in BMI. Her depression, anxiety and stress scores reduced from 4, 8 and 10, respectively to 0, 0 and 4 respectively post three months protocol. Her menstrual cyclicity improved to be between 35-40 days. In present case along with medical management, exercise protocol may have added benefit.
The present case reports aimed to perform a preliminary assessment of the beneficial effects of an individualised, structured physiotherapy exercise program in two adolescent girls with PCOS. This was the first study indicating the effect of structured exercise regime in adolescent girls. Findings suggest that individualised structured supervised physiotherapeutic regime along with dietary counselling and active lifestyle may be effective in improving physical and psychological parameters in young girls with PCOS.
In first case study, the BMI reduced by 9.59% similar to findings of previous studies conducted on adolescents provided with dietary modification or lifestyle modification for three months, six months and 12-months duration (Table/Fig 3) (2),(3),(4),(5),(6),(7),(8),(9). Although, in lifestyle intervention studies aerobic exercises were included while in present case study combination of aerobic and resistance training was included. Combination exercise training result in greater benefits as it counteracts the potential decrease in muscle mass associated with aerobic training driven weight loss (10). In contrast increase in BMI in second case study may be attributed to the process of sexual maturation during which girls tend to gain Fat Free Mass Index (FFMI) and Body Fat Mass Index (BFMI) and further use of combined oral contraceptives have been associated with non significant weight gain (11),(12). Although, in another study no differences were obtained on BMI and BMI percentage (13). Further in a meta-analysis it has been stated that as height is not stabilised during adolescence thus, it can affect BMI measurements (14).
In both case studies, menstrual cyclicity improved. In one case it improved from 2 cycles to 2.25 cycles and in other case also it regularised for 3-4 days per cycle. Similar findings were achieved after administration of three months yoga program and six months dietary intervention (6),(15). Weight management may contribute towards improvement of menstrual dysfunction among young PCOS girls (2),(8). In case of abnormal uterine bleeding progestin (medroxyprogesterone) is known to act by stabilisation of the endometrium (16).
In index cases, hip and waist circumference, SBP and DBP remain unchanged. Previous studies conducted on adolescents with high BMI have indicated an association between reductions in blood pressure with weight reduction (4), but in present cases as none of the adolescent recruited was obese so no blood pressure changes were observed.
VO2 max was found to be improved with reduction in BMI which may be attributed to progressively challenging exercise protocol, though in another case with increase in BMI it reduced slightly. No significant improvements in VO2 max were reported in previous studies following 12 week exercise regime or 24 week diet and exercise regime (17),(18). Although, improvements in VO2 max were reported in overweight or obese adolescent girls after a six week physical activity intervention program (19).
Anxiety scores on DASS-21 improved in both the cases and were within normal range. Aerobic exercises have proved to be effective in improving anxiety scores by regulation of the Hypothalamic-Pituitary-Adrenal (HPA) axis, increase in serotonergic and noradrenergic levels in the brain and endogenous opioid release (20),(21). Although, not many studies have analysed the effect of exercise training on anxiety in persons below 18 years.
Depression and stress scores in both the cases were within the normal ranges pre intervention and post intervention. After three months regime further reduction in scores on both the parameters were noted despite that behavioural modification strategy was not a part of the protocol. Cognitive behavioural therapy has shown to improve the depression score with and without weight reduction in adolescents with PCOS (3),(22). In another study, behavioural modification was included in lifestyle therapy but its effects were not studied on psychological parameters of PCOS adolescents (7).
In the present case reports, the effect of three months of supervised exercise intervention with nutritional counselling was not analysed on the biomarkers. Change in biomarkers (insulin resistance, glucose, anti-mullerian hormone, androstenedione, Dehydroepiandrosterone sulfate (DHEAS) levels etc.,) can provide mechanistic explanations towards improvement of psychological parameters among adolescents. Also, behavioural modification or cognitive behavioural therapy was not included as a component of lifestyle modification protocol.
A three month individualised supervised lifestyle intervention consisting of aerobic and resistance training with dietary counselling may be effective in managing symptoms and psychological parameters of adolescents with PCOS. Inclusion of combination treatment containing lifestyle management with oral contraceptive may have some adverse effects. For further studies along with exercise, inclusion of behavioural therapy in lifestyle management is warranted.
DOI: 10.7860/JCDR/2022/52941.15936
Date of Submission: Oct 20, 2021
Date of Peer Review: Nov 25, 2021
Date of Acceptance: Dec 31, 2021
Date of Publishing: Feb 01, 2022
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Oct 21, 2021
• Manual Googling: Dec 30, 2021
• iThenticate Software: Jan 05, 2022 (1%)
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