Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018




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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Lucknow
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On Aug 2018




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Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
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Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


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.
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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.
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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

Important Notice

Original article / research
Year : 2022 | Month : April | Volume : 16 | Issue : 4 | Page : UC10 - UC13 Full Version

Assessment of Preoperative Anxiety among Patients Attending a Preanaesthetic Check-up Clinic at a Tertiary Care Hospital, Odisha: A Cross-sectional Study


Published: April 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/52737.16254
Partha Sarathi Mohapatra, Krishna Mishra, IPSA Mohapatra, Amit Kumar

1. Associate Professor, Department of Anaesthesiology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India. 2. Assistant Professor, Department of Community Medicine, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India. 3. Associate Professor, Department of Community Medicine, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India. 4. Senior Resident, Department of Community Medicine, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India.

Correspondence Address :
Krishna Mishra,
Assistant Professor, Department of Community Medicine, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India.
E-mail: dr.kmishra89@gmail.com

Abstract

Introduction: Anxiety during the preoperative period predisposes to postoperative complications such as increase in postoperative pain, delay of healing and prolonged hospital stay.Further, patients with a high level of preoperative anxiety require higher doses of anaesthetic agents and recover poorly. Due to these factors, each tertiary care hospital should have an idea about the prevalence of preoperative anxiety in their setting, so that appropriate preventive measures can be planned.

Aim: To assess the prevalence of preoperative anxiety in patients attending the Preanaesthetic Check-up (PAC) clinic for elective surgeries and to find out the factors associated with anxiety among them.

Materials and Methods: This hospital-based, cross-sectional study was conducted in the PAC Clinic at Kalinga Institute of Medical Sciences (tertiary care hospital), Bhubaneswar, Odisha, India, from May to July 2018. The study included 100 patients, using convenient sampling technique, undergoing preanaesthetic check-up, before the proposed elective surgeries. A researcher made study tool, using Hamilton-A (HAM-A) scale, for assessing preoperative anxiety was used. Data was analysed using Epi Info software. A p-value <0.05 was considered as statistically significant.

Results: Among the sampled 100 study participants, preoperative anxiety was found to be present in 97, 72 of the study participants had mild anxiety, 14 had mild to moderate and 11 moderate to severe anxiety. Of the 97 participants who had preoperative anxiety, 7 (14.89%) of the females had moderate to severe anxiety as compared to 4 (8%) of males. The age group of 60-69 years and Christianity religion were found to be statistically significant factors associated with anxiety in the study population.

Conclusion: The prevalence of preoperative anxiety among the study participants was found to be high. Preventive measures like counselling sessions to address their apprehensions should be planned to decrease the anxiety.

Keywords

Anaesthetic agents, Elective surgery, Hamilton-A scale

Hospitalisation and surgery are considerable critical life events having a negative effect, often abruptly imposed that may cause considerable stress (1). Operation and anaesthesia increase the feeling of anxiety (2). It is a compound phenomenon having different components such as psychological, motor, somatic, vegetative and metabolic. The dimension of the anxiety has an influence on the time of recovery, quantity of complications and the discomfort felt by patients. Various studies report different prevalence of anxiety. An Indian study reported the prevalence of anxiety as 72.6%, whereas a Nigerian study reported the prevalence to be 51% (1),(2).

The prevalence of preoperative anxiety varies depending on the place of assessment and the type of scale used. The dimension of anxiety can be measured in many ways; questionnaires being one of the methods of taking an objective measurement. The Hamilton Anxiety Rating Scale (HAM-A), which is a validated scale used for assessing anxiety in patients, is used in the present study. This scale enables the estimation of the efficacy of the preoperative preparing methods and the dynamics of anxiety during the hospitalisation. Monitoring of the anxiety can be very useful in decreasing the fear and improving surgical outcomes related to anaesthesia (3),(4).

There is paucity of data related to preoperative anxiety in this part of Odisha. Hence, the present study was planned, to estimate the prevalence of preoperative anxiety and factors that may influence the patient’s preoperative anxiety level, so that, appropriate preventive and curative measures can be planned to have better surgical outcomes.

Material and Methods

This hospital-based, cross-sectional study was conducted in the PAC clinic of Department of Anaesthesiology at Kalinga Institute of Medical Sciences (tertiary care hospital), Bhubaneswar, Odisha, India, from May to July 2018. A sample size of 100 was considered, convenient sampling technique was used to recruit participants, which included only the patients attending the PAC clinic on Mondays and Fridays for undergoing elective surgeries and satisfying the inclusion and exclusion criteria. The study was initiated after getting Institutional Ethical Clearance (KIMS/KIIT/IEC/48/2018).

Inclusion criteria: Patients of either sex visiting for PAC, aged 18 years and above, those undergoing General Anaesthesia (GA) or Spinal Anaesthesia (SA) and those who gave written informed consent for participation were included for the study.

Exclusion criteria: Uncooperative patients, those with previously diagnosed anxiety or depression on psychiatric treatment, and the ones in whom bedside PAC was done were excluded from the study.

Study Procedure

It was a researcher-made questionnaire comprising of two sections:

Part A: Socio-demographic and behavioural data was collected as per the World Health Organisation (WHO) STEPS questionnaire (version 3.1) (3).

Part B: Hamilton Anxiety Rating Scale (HAM-A) (4).

The second part of the questionnaire (Part B) used in the present study constituted of the HAM-A to assess the anxiety status of the study participants when they went for PAC. The scale consists of 14 items, each defined by a series of symptoms, and measures both psychic anxiety (mental agitation and psychological distress) and somatic anxiety (physical complaints related to anxiety).

Each item is scored on a scale of 0 (not present) to 4 (severe), with a total score range of 0-56, where:

• <17: mild severity,
• 18-24: mild to moderate severity
• 25-30: moderate to severe anxiety

The study tool was validated by three subject experts. Each study participant was explained about the purpose of the study and a written informed consent was obtained from each one of them. Those patients, in whom moderate to severe anxiety was diagnosed appropriate management was done before the proposed surgery.

WHO STEPS Surveillance manual (5):

Operational definitions used in the study:

Tobacco users:

a. Current tobacco users: Percentage of daily and current (daily plus non daily) tobacco users, includes smoking and smokeless, among all respondents.
b. Former daily smokers and former smokers: Percentage of former daily smokers among all respondents and among ever daily smokers, and the mean duration, in years, since former smokers quit smoking.

Alcohol consumption:

a. Current users: Those who have drank alcohol in the past 30 days.
b. Past users: Those respondents who have past 12 months abstainers.

Employment status: Proportion of respondents in paid employment and those who are unpaid. Unpaid includes persons who are non paid, students, homemakers, retired and those who are unemployed.

Literate and illiterate: As per census, a person aged seven and above who can both read and write with understanding in any language, is treated as literate. A person, who can only read but cannot write, is not literate. A person who can neither read, nor write in any language is considered as illiterate (6).

Statistical Analysis

The collected data was coded and entered in MS Excel and analysed using Epi Info TM software version 7.2.4.0. Descriptive statistics was used to represent the results as frequencies, percentages and means. Between groups percentages was compared with Chi-square for observed differences. A p-value less than 0.05 were considered to be significant in the present study.

Results

The present study was carried among 100 patients attending the PAC clinic for preanaesthetic evaluation, regarding fitness for surgery. In the present study 52 participants were males and 48 were females. The mean age of the study participants was 52.76±17.41 years. Overall, 28 participants were in the age group of 45-59 years. On assessing the anxiety status, using the HAM-A scale while undergoing PAC, it was found that 97 patients had some anxiety; 72 had mild anxiety, 14 had mild to moderate severity, 11 moderate to severe anxiety, whereas three had no anxiety (belong to age group: 18-29 years). Among those with mild anxiety, majority (23%) were in the age group of 45-59 years, while 35.7% of those with mild to moderate anxiety were in the age group of 60-69 years (Table/Fig 1).


Overall, 15 (57.7%) of those in the age group of 60-69 years had mild anxiety and this was also found to be statistically significant (p-value=0.04). It was also seen that the females reported a higher prevalence of anxiety. Mild anxiety was seen in 30 (63.82%), 11moderate to severe anxiety was found in 10 (21.28%) where as severe anxiety was found in 7 (14.89%) of females. Among the Christians 2 (66.67%) had mild to moderate anxiety which was found to be statistically significant (p-value=0.03). (Table/Fig 2) represents the behavioural risk factors among study participants and their association with preoperative anxiety.

Discussion

The present study was conducted among the patients planned for elective surgery in a tertiary care hospital. The prevalence of preoperative anxiety was found to be 97%. The prevalence of mild anxiety was 72% whereas 14% of the study participants had mild to moderate severity and 11% moderate to severe anxiety, 3% had no anxiety. The HAM-A was used in the present study to assess the preoperative anxiety of the study participants. A similar study done in Odisha, using the HAM-A and Hamilton Depression Rating Scale, reported the prevalence of anxiety as 43.3% and depression among 38% of the study participants (7). These differences might be due to differences in sample size. Another similar study done in Tamil Nadu using the Amsterdam Preoperative Anxiety and Information Scale (APAIS) reported the prevalence of preoperative anxiety as 58.1% in patients undergoing day care surgeries (8).The lower prevalence of preoperative anxiety might be due to the reason that daycare surgical procedures are usually short with less complications and shorter hospital stay, amounting to lesser anxiety level as compared to major elective surgeries, where patients are exposed to longer procedures with longer hospital stay. The difference in the findings might also be due to the difference in the scales used.

A study done in Delhi among patients undergoing valvular heart surgery at a tertiary care hospital using HAM-A scale; reported that around 81.66% of the patients had moderate anxiety (9). This finding is higher than the finding of the current study. There was significant association of preoperative anxiety with the sleep quality and female gender in the discussed study whereas the present study indicates a statistically significant association between the age group of (60-69 years) and religion (Christianity); although there was a higher prevalence of preoperative anxiety among females in the current study, but it was not found to be statistically significant (p-value=0.07). The reason for higher prevalence of preoperative anxiety among females has been linked to the poor sleep quality in the former study.

A study done in China, to assess anxiety among patients with essential tremors, using the HAM 24-item scale reported the prevalence of anxiety to be 63.3%. It also reported a significant association of preoperative anxiety with female gender (10).The prevalence of higher anxiety among females is similar to the finding of the present study; however, in the present study this difference was not found to be statistically significant. Another study done in Ethiopia, among adult surgical patients, reported the prevalence of preoperative anxiety as 61% among the study participants, using the State Trait Anxiety Inventory Scale (STRAI scale) (11). Another similar study done in Brazil among geriatric population undergoing transvesical prostatectomy, using HAM-A reported that 10.9% of the participants showed no anxiety, 40.6% had mild, 31.2% moderate and 17.9% had intense anxiety (12).

The present study reported a lower percentage of study population with severe anxiety. Another Brazilian study done among hospitalised surgical patients, reported the prevalence of preoperative anxiety as 53.0%, and the prevalence of moderate and severe anxiety was 33% among the anxious patients (13). Another similar study done in Brazil using the Hospital Anxiety and Depression Scale (HADS), it was found that there was statistically significant association between gender where females reported higher anxiety levels and higher age groups were found to have lower anxiety levels (14). This might be due to the fact that older age group in the above study might be having more co-morbidities resulting in frequent or prolonged hospitalisation leading to subsequent decrease of anxiety in a hospital environment. The result of the present study is partly similar with the above study with respect to association with gender. A study done in Pakistan using the Hamilton-A scale reported that around 2.9% of the study participants had no anxiety, 30.0% had mild anxiety, 42.9% had moderate anxiety, 12.9% had severe anxiety and 11.4% had very severe anxiety (15). These findings are similar to the findings of the present study.

Screening of preoperative anxiety might be included as a routine evaluation during the PAC in the present Institution. More studies based on targeted interventions should be taken up in order to achieve lower levels of preoperative anxiety so that the adverse reactions due to anxiety may be avoided. A pre-post study with ‘counselling’ as intervention, will further help in generating evidence on effectiveness and role of ‘patient-centric counselling’, in dealing with preoperative anxiety.

Limitation(s)

Due to inherent cross-sectional nature of the study design, causality cannot be ascertained. Hamilton-A scale based on self-reporting may have issues of reporting bias.

Conclusion

The prevalence of anxiety ranges from low to high as reported in many studies but the preoperative anxiety in this study was found to be high. Early screening and prompt intervention as a regular practice by the anaesthetists, may help in decreasing the fear of surgery and eliminating preoperative anxiety. This might help in decreasing the complications during and after surgery. A brief idea about the type of surgery the patient is about to undergo, the length of the surgery, the risks and benefits of the surgery, might help in relieving the anxiety preoperatively.

References

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Daria U, Kumar V. Prevalence and factors responsible for preoperative anxiety in elective surgical patients. International Journal of Scientific Research. 2018;7(4):35-38.
2.
Akinsulore A, OwojuyigbeAM, Faponle AF, Fatoye FO. Assessment of preoperative and postoperative anxiety among elective major surgery patients in a tertiary hospital in Nigeria. Middle East journal of Anaesthesiology. 2015;23(2):235-40.
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WHO STEPS Instrument (Core and Expanded). Available from: https://www.who.int/ncds/surveillance/steps/STEPS_Instrument_v2.1.pdf. [Accessed 1st October 2021].
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Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol. 1959;32:50-55. [crossref] [PubMed]
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WHO STEP wise approach to chronic disease risk factor surveillance. Available from: https://www.who.int/ncds/surveillance/steps/STEPS_Instrument_v2.1.pdf. [Accessed 1st October 2021].
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Census 2011. Rural and Urban distribution. Literacy of rural and urban. Chapter VI. Paper 2, Volume 2, A.P. Available from: https://censusindia.gov.in/2011-prov-results/paper2. [ Accessed 21st November 2021].
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Panda S, Samantaray N, Patanaik M, Sahoo D, Sarangi A, Jena S. Assessment of level of depression and anxiety in pre- and postoperative stages: A prospective cross-sectional study in SCB Medical College, Cuttack. Apollo Med. 2019;16:22-25.
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DOI and Others

DOI: 10.7860/JCDR/2022/52737.16254

Date of Submission: Oct 06, 2021
Date of Peer Review: Nov 13, 2021
Date of Acceptance: Jan 22, 2022
Date of Publishing: Apr 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. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Oct 09, 2021
• Manual Googling: Jan 21, 2022
• iThenticate Software: Feb 12, 2022 (16%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
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  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
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  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
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