Article in PDF
How to Cite
Citation Manager
Readers' Comments (0)
Audio Visual Article Statistics
Link
to PUBMED
Print this Article
Send to a Friend
Advertisers
Access Statistics Resources
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
Subclinical Hypothyroidism among Overweight and Obese Children: An Observational Cross-sectional Study
Correspondence Address :
Dr. Himanshu Verma,
ESI Colony, Basaidarapur, New Delhi, India.
E-mail: h.verma.himanshu@gmail.com
Introduction: Subclinical Hypothyroidism (SH) is often treated by thyroxine hormone by general pediatricians considering deranged thyroid profile, attributing the derangement to be the cause of obesity. However, childhood obesity increases the risk of SH by means of adaptive mechanisms.
Aim: To study the prevalence of SH and their lipid profile derangement in overweight and obese children of Indian population.
Materials and Methods: The present cross-sectional study was conducted in 60 children, between 5 to 15 years of age, presenting in the Department of Paediatrics at ESI PGIMSR Basaidarapur, New Delhi, India from October 2019 to April 2021. The children were grouped into two with 30 in each-overweight (Body Mass Index (BMI) between 23rd to 27th adult equivalent) and obese (BMI more than 27th adult equivalent) children. They were assessed for biochemical derangement including thyroid profile and lipid profile. The data were analysed using the Statistical Package for the Social Sciences (SPSS) Version 21.0 (IBM, Chicago, USA).
Results: The mean age of the study sample was 9.3 years and male/female was 41/19. Mean BMI of the obese children was 24.24 kg/m2 and that of overweight was 20.4 kg/m2. Seven (23.33%) children in overweight group and nine (30%) in obese group were diagnosed with SH (normal T4 with high TSH level). Nine out of the total 16 children with SH also had dyslipidaemia.
Conclusion: About 23% in overweight and 30% in obese children were found to have subclinical hypothyroidism. Nine out of these 16 children with subclinical hypothyroidism also had dyslipidaemia.
Body mass index, Dyslipidaemia, Thyroid stimulating hormone
Obesity is increasing worldwide with children being no exception. There is an ever-growing focus on the relationship between thyroid homeostasis and weight status. Elevated serum concentrations of Thyroid-Stimulating Hormone (TSH) combined with normal serum concentrations of free thyroxine (fT4) is termed as Subclinical Hypothyroidism (SH) (1),(2),(3). SH is a diagnosis of exclusion that does not cause any clinical symptoms of hypothyroidism. There is always a dilemma whether the raised TSH level found in obese children is a cause or consequence of obesity and whether they require treatment or not (4),(5). Most studies demonstrate a positive correlation between BMI and serum TSH level (6),(7),(8). SH in obesity is caused by a reduced thyroid function or reflects an adaptive mechanism against obesity in order to increase energy expenditure remains to be clarified. Some studies in obese children have reported improvements in thyroid status by reductions in TSH concentrations during weight loss (6),(7). SH has also been suggested as a risk factor for cardiovascular and metabolic disorders such as hypertension and dyslipidaemia (9),(10). According to published studies, overweight and obese children are prone to develop SH, which is a physiological compensatory condition (11),(12),(13). There is a paucity of data in Indian children, therefore, this study was planned to find out the prevalence of SH in overweight and obese children.
This was a cross-sectional study conducted in the Department of Paediatrics, ESI-PGIMSR and Model Hospital Basaidarapur, New Delhi, India from October 2019 to April 2021. The approval from Institutional Ethics Committee (IEC) was obtained vide IEC number-DM(A)H-19/14/17/IEC/2012-PGIMSR. Informed consent was taken from parents of children age <7 years and assent was taken from children >7 years.
Inclusion criteria: Children aged 5-15 years, with minor illnesses, who were overweight or obese as per the Indian Academy of Pediatrics (IAP) BMI chart 2015 (14). Initially, 150 children of 5-15 years age group were meant to be included in this study, however, due to COVID-19 pandemic, the number of children attending hospital for routine illness decreased and hence the number of study subjects was reduced to 60 (30 in each group, overweight and obese) due to time constraints.
Overweight group: Thirty children having BMI value between 23rd to 27th adult equivalent.
Obese group: Thirty children having BMI value >27th adult equivalent cut-off.
Exclusion criteria: Children with any major illness or congenital malformations, and those with endogenous cause of obesity were excluded from the study.
The children included in the study were assessed for clinical history, including any concurrent illness, past illness, drug intake, birth history, immunisation history, developmental history, family history, personal history, dietary assessment and socio-economic profile. Height was measured using sliding stadiometer with an accuracy of 0.1 mm. Weight was recorded using electronic weighing machine calibrated to 0.1 kg accuracy. Five mL of blood sample from peripheral vein was collected after overnight fasting and assessed for biochemical derangement of fT4, fT3, TSH, lipid profile after processing in laboratory by using chemiluminescence assay (Table/Fig 1).
Statistical Analysis
The presentation of the categorical variables was done in the form of number and percentage (%). The comparison of the variables which were qualitative in nature was done using Chi-square test. If any cell had an expected value of less than five then Fisher’s-exact test was used. The data entry was done In the Microsoft Excel spreadsheet and the final analysis was done with the use of the Statistical Package for the Social Sciences (SPSS) software, (IBM, Chicago, USA), version 21.0. For statistical significance, p-value of <0.05 was considered statistically significant.
Total of 60 children were included, who were categorised into two groups (overweight and obese) of 30 subjects each based on their BMIs. Male: female ratio was 2.2:1 (41M:19F), with mean age at presentation being 9.3 years. Mean BMI of obese children was 24.24 kg/m2 and of overweight children was 20.4 kg/m2.
Overweight group had high TSH level in 7 (23.33%) children and the obese group had high TSH level in 9 (30%) children (Table/Fig 2).
Dyslipidaemia was present in total 27 (45%) out of 60 children in overweight and obese groups; in which 9 (33.3%) had SH with mean TSH value of 4.59±1.35. Therefore, nine children had SH with dyslipidaemia (Table/Fig 3).
In SH with dyslipidaemia, two children had raised cholesterol, 16 had raised triglyceride and one had low HDL (Table/Fig 4).
Obesity is an evolving epidemic affecting the paediatric population with significant numbers seen in developing nation like India. These obese children are prone to developing diabetes mellitus, SH, hypertension, and osteoarthritis. SH is a common biochemical parameter in these children and when these results are interpreted by general practitioners, they commonly treat the children with thyroxin attributing to cause of obesity, therefore, the present study was conducted and it was found that prevalence of SH is 7 (23.33%) in overweight group and 9 (30%) in obese children. Shalitin S et al., found a prevalence of SH in 22.2% of 207 obese 5 to 18-year-old, Marras V et al., found deranged thyroid profile (84 had elevated fT3 levels, 15 elevated TSH, six elevated fT4, three elevated fT3 and TSH, and one elevated fT3, fT4 and TSH levels) in 23% of 468 obese children aged 3.7 to 17.9 years (11),(12). Dahl M et al., demonstrated a prevalence of SH in 10.4% of Danish obese children (13). Thus, the present study also showed findings in accordance with the above-mentioned studies and concluded the same prevalence of SH among overweight and obese children. Dyslipidaemia was present in total 27 (45%) out of 60 children of overweight and obese in which 9 (33.3%) had SH also.
In this study, one child had high TSH and high T4 level in overweight group. Obese group had two children with high TSH and high T4 level and another child had normal TSH and high T4 level. Reinehr T suggested that elevated TSH with high T4 level is a hyperthyrotropinaemia condition, and hypothesised a link between chronic inflammation of thyroid gland in obese children. It was suggested that there was no need of any treatment for SH, raised T4 and T3 levels since these conditions seem to be consequences rather than a cause of obesity (15). However, it is advocated to keep these children under follow-up and monitor them for biochemical derangements.
Among the various hypotheses for increase in TSH levels in obesity, it may be due to an increase in leptin-mediated production of prothyrotropin-releasing hormone. Also, decrease in T3 receptors in the hypothalamus may impair the feedback and decrease in peripheral deiodinase activity. There are also studies showing decreased TSH levels following weight loss which may be indicative of obesity being the cause rather than a consequence of raised TSH (15). Thus, it can be concluded that overweight and obese children were more prone for SH and dyslipidaemia.
Limitation(s)
The number of study subjects was low due to the COVID-19 pandemic. Due to the lockdown, hospital visit of patients with minor illnesses was also low.
Prevalence of SH was 23.33% in overweight children and 30% in obese children of age group 5-15 years; nine children out of total 16 children of SH also had dyslipidaemia. Therefore, overweight and obese children often develop SH, however, in the absence of clinical and laboratory evidence, therapy with thyroid hormone seems unnecessary. Also, one should evaluate for changes in thyroid function tests with weight loss in these children during follow-up.
DOI: 10.7860/JCDR/2023/60524.17263
Date of Submission: Sep 30, 2022
Date of Peer Review: Oct 27, 2022
Date of Acceptance: Dec 03, 2022
Date of Publishing: Jan 01, 2023
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: Sep 30, 2022
• Manual Googling: Nov 28, 2022
• iThenticate Software: Dec 02, 2022 (16%)
ETYMOLOGY: Author Origin
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
- Index Copernicus ICV 2017: 134.54
- Academic Search Complete Database
- Directory of Open Access Journals (DOAJ)
- Embase
- EBSCOhost
- Google Scholar
- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
- Journal seek Database
- Popline (reproductive health literature)
- www.omnimedicalsearch.com