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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
Surface Electromyography of Perianal Muscles in Children with and without Enuresis: A Cross-sectional Study
Correspondence Address :
Dr. Padmaja Guruprasad,
Pimpale Gurav, Pune, Maharashtra, India.
E-mail: padmajag1997@gmail.com
Introduction: Enuresis or bedwetting is the most common urological problem seen in children from the age of 5-15 years. Various diagnostic procedures like urodynamics study, urinary system ultrasonography and Electromyography (EMG) are widely used. In most cases, endoanal probe is used for the procedure of EMG which is an invasive technique but surface EMG is pain free and easier.
Aim: To assess the activity of perianal muscle in children with enuresis using surface EMG.
Materials and Methods: Present study was a cross-sectional study in which 20 healthy children and 20 enuretic children in the age group of 5-15 years participated. Both boys and girls without central nervous system disorder were included. Surface EMG of the perianal muscles were performed. The homogenecity of demographic data like age, weight and height were checked using Student’s t-test. Normality of the data was established using Shapiro-Wilk’s test.
Results: On analysis, the mean age (years) of normal children was 8.75±2.09 and for enuretic children was 9.3±2.63. The mean value of amplitudes of surface EMG (Quotient of Motor Unit action Potential-QMUP) in normal children was 428.6±118.6 µV and for enuretic children was 248.01±45.85 µV (p<0.05). Mean score for enuretic girls was 260±42.95 and normal girls was 414.7±118.1 (p<0.05). Similarily, mean score for enuretic boys was 236±47.71 and normal boys were 442.8±123.7 (p<0.05).
Conclusion: The perianal muscle activity is lowered in children with enuresis than in their age matched normal children. In the enuretic children, there is a need to manage pelvic floor muscle strength along with neuronal control.
Bedwetting, Electrodiagnosis, Paediatric population, Pelvic floor muscles, Urodynamics
The International Children’s Continence Society (ICCS) defines enuresis as a involuntary voiding of urine during the day and/or night (1). The children usually are able to let the parents know when they have the urge to pee by the age of 5-6 years, but in some children it is difficult to attain the control that is known as bedwetting. This is mostly common in the age group of 5-15 years (1),(2). Bedwetting can be caused due to wide range of factors such as maturation delay, genetic factors, sleep disorders, behaviour and psychological factors, and endocrinal system causes (1).
Primary nocturnal enuresis is defined as the involuntary voiding of urine during the night. In this type of enuresis, the child never achieves control of his/her bladder (3). Secondary nocturnal enuresis is defined as the re-occurrence of bedwetting after achieving of bladder control. The child begins to have episodes of bedwetting after having achieved control, i.e., after having six months of dry period (3).
There many evaluations that are performed to assess and diagnose enuresis. The most commonly assessed parameters are like urinalysis and urine culture, urinary system ultrasonography, urodynamic studies, EMG of the pelvic floor and many more. EMG is a diagnostic procedure that is used for assessment of muscle function. It is commonly used in conditions involving the central nervous system and peripheral nervous system. This method is very useful in giving a visual feedback in the form of graphs. EMG can be used in assessment of pelvic floor muscle in the children with enuresis by using various electrodes like endoanal probes, vaginal probes, and button electrodes (4). Endoanal probes and vaginal probes are invasive and expensive. So, there is a need to assess these muscles in an easier and non invasive method. Surface EMG using the button electrode is a non invasive electrodiagnostic method. Perianal muscles are easier to assess with surface button electrodes. It is especially useful in children. It can be used as a diagnostic tool as well as an intervention (5).
Perianal muscles are part of assessment of pelvic floor muscle surface EMG. It can be assessed in various positions such as supine, sitting and standing. Each maneuver helps in recruitment of muscles. Children are able to activate their pelvic floor muscles separately from the adjacent hip and abdominal muscle groups (4). So, surface EMG of perianal muscle was performed by button electrode in this study. This study aimed to assess bladder function using surface EMG of perianal muscles in the children with enuresis.
This cross-sectional study used purposive sampling method and was conducted in Dr DY Patil College of Physiotherapy from October 2020 to March 2021. Ethical clearance was taken from the Ethical Committee of the Institute {Ethical approval no: DYPCPT/IEC/28/2020.)} and the trial was also registered in Clinical Trials Registry India (CTRI Reg no.: CTRI/2020/12/029496.) Total of 60 children were screened and the ones that fit the criteria were included in this study. Twenty healthy children and equal enuretic children who fit the inclusion criteria were selected.
Inclusion criteria: Children having age between 5-15 years, children with history of daytime/night time bedwetting, history of bedwetting for atleast two times a week and duration of bedwetting for atleast three consecutive months (1).
Exclusion criteria: Children with any CNS involvement, any sort of developmental delay, presence of bladder infections, and those taking medications for the management of enuresis, were excluded from the study.
Procedure
Diagnosis of all the enuretic children was confirmed in the presence of paediatricians at the institute where the study took place.
Testing position: A patient was asked to lie in supine with both the knees flexion (crook lying) (6). The guardian or the parent was asked to be present in the room while the surface EMG was being performed. The surface EMG was performed using button electrodes.
Placement of electrodes: The cathode and anode were placed at the perianal region and the ground electrodes were placed on the thigh to complete the circuit.
Recording of surface EMG readings: The child was instructed to squeeze their knee.
The therapist took 3 readings.
• No contraction (Spontaneous activity- SPA): The child was instructed to stay relaxed for SPA reading. The reading of SPA was recorded as 0.
• Maximum Voluntary Contraction (MVA): The child was asked to contract his/her perineum as if they are controlling their urge to micturate for 10 seconds. Here, the peak-to-peak amplitude was measured as the outcome measure.
• Maximal voluntary contraction (QMUP): The child was asked to contract their perineum maximum capacity for 10 seconds. The average amplitude was recorded as outcome measure.
Statistical Analysis
Sample size estimation was done using Open Epi software version 3.01. The calculated sample size of the study was 39 at 95% confidence level and allowable error was 6%. Data was analysed using primer of biostatistics version 7. The homogeneity of the samples was checked using the Student’s t-test. Normality of the data was checked by using Shapiro-wilk’s test. Further analysis of the amplitudes of surface EMG was performed using Mann-Whitney test where the p-value was set at 95% confidence interval (p<0.05).
The mean age in the group of normal children was 8.75±2.09 years and for enuretic children was 9.3±2.63 years (p-value 0.47). The mean of SPA readings were 0 µV. For quantitative analysis, authors used the values of QMUP (Table/Fig 1). There was a significant difference in the QMUP values of surface EMG between normal and enuretic children. There was also a significant difference between in QMUP values of surface EMG among each gender of normal and enuretic group. However, there was no significant difference found between genders within the normal and enuretic group (Table/Fig 2), (Table/Fig 3), (Table/Fig 4).
One of the causative factor of enuresis is pelvic floor muscle weakness. Surface EMG is a non invasive electrodiagnostic method which helps in analysing the activity of the muscle with a visual representation in the form of graphs (7). Wennergren H and Oberg B concluded that EMG can be used as a tool of assessment in children (5). So, that the pelvic floor muscle can be recruited (8). Another study performed by Glazer HI et al., was to understand the reliability of using surface EMG for pelvic floor muscle assessment this study concluded that surface EMG is highly reliable (9). The present study found significant difference (p<0.05) in the mean score of peak-to-peak amplitude for pelvic floor muscles between normal and enuretic children. A study conducted by Abd El-Moghny SM et al., (6) on children with Primary Monosymptomatic Nocturnal Enuresis (PMNE) found a significant decline in pelvic floor muscle activity peak when comparing each PMNE group with its age matched normal group. They concluded that the peak (X±SD) significantly changed (p=0.001) from 199.3±1.0, 200.9±0.9, and 201.9±1.2 of normal groups to 90.0±0.8, 92.1±1.1, and 93.9±0.9 of PMNE groups, for age-matched categories 8, 9, and 10 years, respectively. The percentages of peak decline in PMNE groups from normal groups were 54.8%, 54.2%, and 53.5% for age-matched categories for 8, 9, and 10 years, respectively (6).
In the present study, there was a significant difference between the amplitude of the surface EMG of the pelvic floor muscles in children suffering from enuresis. It only goes to prove that, the weakness in the pelvic floor muscles could be one of the reasons of bedwetting in children with enuresis (10). This was in agreement with the study performed by Kulaksizog?????lu H et al., they aimed to find out the efficacy of pelvic floor muscle training in Overacting Bladder (OAB). They found that pelvic floor muscle training helps in improving bladder function. They also stated that in normal physiological process, the pelvic floor muscles and bladder functions are controlled from the level of pontine micurition centre (11). Abd El-Moghny SM et al., reasoned that the pelvic floor muscles activity suppression in children with PMNE could be attributed to the neural control of continence which involves a competent sphincter mechanism, including not only the sphincter striated and smooth muscle but also the pelvic floor muscle via a physiological spontaneous activity called “tonic” which depends on prolonged activation of certain tonic motor units leading to increased pelvic floor muscle activity with bladder filling (6).
Another research studied the prevalence and determinants of nocturnal enuresis in school going children in southern Maharashtra found that the prevalence of nocturnal enuresis in boys (14.34%) was significantly more than the prevalence in girls (8.31%). So, in the present study the comparison between the gender was analysed, but it showed that there was no difference in the pelvic floor muscle strength in enuretic girls and boys. It proves that the pelvic floor strength may not be the direct cause for the higher prevalence in boys (2).
So, there is a need to conduct a study with a larger population along with comparison between genders for pelvic floor muscle electrodiagnosis.
Limitation(s)
The sample size selected was small and were collected from a restricted area. Also, the socio-economic status and the stress levels of the children were not taken into consideration.
This study concluded that there was decrease in the perianal muscle activity in children with enuresis as compared to normal. There was no gender-wise significance found in QMUP of pelvic floor muscles. This further helps in understanding the role of pelvic floor muscle training in children with enuresis. Furthermore, the values of the EMG readings of the enuretic children can also be used as a reference values for the pelvic floor activity in children.
DOI: 10.7860/JCDR/2022/50776.15823
Date of Submission: Jun 10, 2021
Date of Peer Review: Jul 24, 2021
Date of Acceptance: Nov 08, 2021
Date of Publishing: Jan 01, 2022
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. No
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