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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
Analysis of Ratio of Length of 2?supnd Digit to 4th Digit (2D:4D) among Transgender Women (MtF) and Cisgender People in South Indian Population: A Cross-sectional Study
Correspondence Address :
Dr. Sathiya Subramaniam,
Associate Professor, Department of Anatomy, Annapoorana Medical College and Hospitals, NH-7 Shankari Main Road, Salem-636308, Tamil Nadu, India.
E-mail: sathiyasho@gmail.com
Introduction: Transgender refers to an individual whose gender identity differs from the sex that was assigned at birth. Transgender women (MtF) were assigned male at birth but later recognised themselves as female. The length of the index finger (2D) in males is shorter than the length of the ring finger (4D), resulting in a low finger ratio due to higher androgen levels, whereas in females, the ratio is high due to low androgen levels. The index to ring finger length ratio in males and females is influenced by testosterone hormone levels during early foetal life, exhibiting sexual dimorphism. The 2D:4D ratio serves as one of the determinants for future generations to identify the transgender women population.
Aim: To determine the 2D:4D ratio among transgender women and the cisgender population.
Materials and Methods: A cross-sectional study was conducted in the Department of Anatomy, Annapoorana Medical College and Hospitals, Vinayaka Mission’s Medical College Hospitals, Salem, Tamil Nadu, India, from September 2018 to October 2019. A total of 392 adult participants between 19 years and 60 years of age were selected. The samples of transwomen were collected with the help of the President of Salem Thirunangaigal Nala Sangam (STNS) and Koovagam Koothandavar Temple in Tamil Nadu. Cisgender samples were collected from volunteers in Salem, Tamil Nadu. The 2D and 4D digit lengths of both hands were measured using Digimizer software with the help of images obtained by a Canon 220 photo scanner. Another type of classification was done by naked eye analysis without any calculations, based on which the 2D:4D ratio among males, females and transgender women was categorised into types 1, 2 and 3. The paired t-test was used to compare the male, female and transwomen populations.
Results: Out of 392 participants, 122 were cis females, 130 were cis males and 140 were transgender females. The p-value of the mean 2D:4D ratio was found to be significant in the right and left hands when comparing the 2D:4D ratio of males with females and transgender women with females. The p-value of the 2D:4D ratio for males with transgender women in the right and left hands was 0.451 and 0.943, respectively, which was statistically insignificant due to the high levels of androgen in these two groups.
Conclusion: The present study helps scientists in the gender study field to advance their knowledge about transgender individuals, which can fill the gaps in available information and overcome existing lacunae in this field.
Androgen, Digit ratio, Index finger, Sexual dimorphism
Transgender studies have become increasingly prominent over the past several decades. The word “transgender” was coined by psychiatrist John F. Oliven of Columbia University in 1965. Transgender refers to an individual’s sense of personal identity that does not conform to their anatomical sex. For gender non conformity, the term transgender can be used. The various terms commonly used under the transgender umbrella are (FtM) for men and (MtF) for women, where individuals change themselves according to what they feel inside (1),(2). Cisgender identity and gender, however, match with the sex at birth. Prenatal androgen exposure in foetuses plays a vital role in determining the digit ratio. Male foetuses show lower (masculine) digit ratios due to more androgen exposure, whereas in female foetuses, the possibility of androgen exposure is less reflected as a higher (feminine) digit ratio (3). Males with a feminine digit ratio are more vulnerable to have low sperm counts, infertility and metabolic syndrome (4). The length of the index and ring finger (2D:4D) ratio varies in males and females as prenatal androgen exposure determines the digit length before birth (5). The 2D:4D ratio was found to be greater in females than males due to exposure to low androgen levels in utero, and the gender difference tends to be more for the right hand than the left hand as the majority of the population were right-handed individuals (6).
The present study not only helps scientists in transgender studies but also assists forensic experts in dealing with medicolegal cases to identify the gender of an unknown individual with residual body parts having only a detached upper limb by measuring the digit (2D:4D) ratio as it shows sexual dimorphism. Therefore the present study was aimed to determine gender differences in digit ratio (2D:4D) between transgender women and cisgender individuals in the South Indian population and to calculate the 2D:4D ratios, determine the percentage distribution among the three genders, and categorise them into types 1, 2 and 3.
A cross-sectional study was conducted in the Department of Anatomy, Annapoorana Medical College and Hospitals, Vinayaka Mission’s Medical College and Hospitals, from September 2018 to October 2019. The Institutional Ethics Committee (IEC) granted ethical clearance for the present study (VMKVMC/IEC/18/62).
Sample size calculation: To calculate the sample size, reference values were available for males and females only; for transgender individuals, the reference values were not available. Therefore, the sample size was calculated based on the effect size. To calculate the sample size for three groups, the assumed medium effect, i.e., E=0.20, was used. The sample size was calculated using the software G Power version 3.1.9.2 with 90% power, resulting in 107 per group and a total of 321 (7). A non response rate of 15% was considered. Therefore, the final sample size of 126 per group and a total of 378 was used.
Inclusion criteria: Cisgender (both male and female) volunteers between 19 years and 60 years and government Certified adult Transgender women (MtF) between the age group 19 years and 60 years were included in the study.
Exclusion criteria: Other genderqueers like transmen (FtM), gay, lesbian, intersex and queer, and transwomen who did not give informed consent were excluded from the study.
Study Procedure
A total of 392 adult samples between 19 years and 60 years of age were selected. Samples from cisgender subjects were collected from Department of Anatomy, Annapoorana Medical College and Hospitals, Tamil nadu, India (cis females, n=50 and cis males, n=39), Vinayaka Mission’s Medical College and Hospitals, Tamil nadu, India (cis females, n=23 and cis males, n=31), and at Salem cis females, n=49 and cis males, n=60). All the samples of transwomen (n=140) were collected with the help of President STNS and Koovagam Koothandavar Temple in Tamil Nadu, India.
Subjects underwent multiple counselling sessions to help them understand the type of the research. Written informed consent was obtained from all interested participants. Out of 500 subjects approached, including cisgender and transgender women, only 392 subjects consented to participate.
Photo scanning image: All volunteers were asked to remove their ornamental jewellery from their fingers, and their hands were cleaned with soap and water to remove dirt. Once their hands were dry, a thin layer of non toxic white talcum powder was applied to the palms and fingers. The white powder enhances the ridges and creases of the hands for computer interpretation. A Canon CanoScan LiDe 220 photo scanner and a personal computer were used to record the image, ensuring that all fingers were straight and visible (A3). While scanning, a measurement scale, the subject’s name and ID number were placed next to the subject’s hand. Both the palmar sides, the subject’s name with ID number and the measurement scale were scanned simultaneously (A1A2). The images were standardised by setting a 10 mm length to 157 pixels (Table/Fig 1).
Software digimizer software: All the scanned images were labelled, converted to grayscale, and inverted to negative for better visualisation with the help of Photoshop 2018 software. Later, all the Joint Photographic Experts Group (JPEG) images were transferred to the Digimizer software for length measurements (Table/Fig 2) (8),(9).
The following measurements were taken on both the right and left hands as specified below (10):
• D2 (Index finger) length was measured between the midpoint of the basal crease and the fingertip.
• D4 (Ring finger) length was measured between the midpoint of the proximal basal crease and the fingertip.
Based on the lengths of the index and ring fingers, they are categorised into three visual types (11):
• Type 1: Length of the index finger longer than the ring finger.
• Type 2: Length of the index finger and ring finger equal.
• Type 3: Length of the ring finger longer than the index finger.
All the above measurements were taken thrice by two investigators, and the mean of the three values was considered as the final value. The readings were taken with 100% agreement by both observers.
Statistical Analysis
A detailed descriptive analysis was done by using Statistical Package for the Social Sciences (SPSS) software version 25.0. The mean, Standard Deviation (SD) and p-value were calculated and compared among cisgender males, cisgender females and transgender women. The paired t-test was used to compare the male, female and transgender women groups. The percentage distribution of each type based on the length of the index and ring fingers among the three genders was tabulated. A significance level of p-value<0.05 was considered significant.
Out of 392 participants, 122 were cis females, 130 were cis males and 140 were transgender females (Table/Fig 3). The mean 2D:4D ratio in the right hand was comparatively greater than in the left hand in all three genders. The mean 2D:4D ratio of the right and left hands in females was higher than in the male and transgender women populations (Table/Fig 4).
The mean 2D:4D ratio between females and males shows a p-value of 0.010 on the right-side and a p-value of 0.001 on the left-hand side. A similar significant result was noted by comparing transgender women and female groups, showing a p-value of 0.001 in both the right and left hands. On the contrary, the mean 2D:4D ratio between transgender women and males showed a p-value of 0.451 on the right hand and a p-value of 0.943 on the left hand, confirming that there is no significant difference between these two groups, clarifying that transgender women’s somatic features are analogous to males (Table/Fig 5).
The percentage distribution of type 3 in males, females and transgender women on the right hand was 44.61%, 32.78%, and 46.43%, respectively, whereas on the left hand, it was 39.23%, 24.60%, and 42.86%, respectively. This implies that in males, the length of the ring finger was greater than the index finger, whereas in females, the length of the ring finger and index finger was the same (type 2) with 14.75% on the right hand and 18.03% on the left hand. Therefore, in males and transgender women, the type 3 finger pattern (Length of ring finger > Length of index finger) was more observed, whereas in females, the type 2 finger pattern was more prevalent than in males (Table/Fig 6).
The pair-wise comparison results show that the mean of females significantly differed from males and transgender women. However, the mean value of males did not differ significantly from transgender women (Table/Fig 7).
The 2D:4D ratio in humans is of considerable interest in research as it exhibits sexual dimorphism. We analysed the 2D:4D ratio in relation to gender identification in the transgender population. The relative 2D:4D ratio might serve as a suitable indirect biomarker for prenatal androgen activity, influencing the masculinising effects on behaviour and secondary sexual characteristics of an individual.
In the present study, the mean 2D:4D ratio of the right hand in males, females and transgender women was found to be 0.9595, 0.974 and 0.9558, respectively. The mean 2D:4D ratio of the left hand in males, females and transgender women was found to be 0.943, 0.9618, and 0.9434, respectively.
A comparison was made between previous and present studies. Results of mean 2D:4D ratios among male, female and transgender women populations are shown in (Table/Fig 8) (11),(12),(13),(14),(15),(16),(17),(18),(19),(20),(21),(22),(23),(24),(25),(26).
Visual classification of index and ring finger: Robertson J et al., studied the 2D:4D ratio in males and females using hand radiographs. The mean 2D:4D ratio in males was less when compared to females and showed a significant difference with p-value<0.001. Based on finger length measurements, the hand was categorised into three types, and it was found that a majority of males fall under type 3 hand (ring finger greater than index finger). In females, type 3 was less in number since the index and ring finger lengths were almost similar, showing type 2. The male pattern 2D:4D finger type in males and transgender women was similar to the present study. However, in females, the percentage distribution of type 3 was less. The non gonadal somatic sex difference that masculinises males due to foetal androgen levels exhibits 2D:4D sexual dimorphism (11).
A 2D:4D ratio in the cisgender population: According to Van Hemmen J et al., Aboul-Hagag KE et al., and Gillam L et al., the mean 2D:4D ratio between females and males shows a significant p-value (<0.001) in both the right and left hand. It was found that the mean 2D:4D values were greater in females than in males, due to prenatal testosterone levels playing a vital role in digit length values, which correlates with the present study (12),(13),(14).
Canan F et al., conducted a study linking Problematic and Pathological Internet Use (PPIU) to 2D:4D ratios in a sample of both females and males, which shows a stronger association in males than in females due to prenatal testosterone concentration leading to addictive video gaming (15).
Dey S and Kapoor AK, and Jacob M et al., conducted a study in the Indian population, which revealed that the mean 2D:4D digit ratio in males (0.968) was significantly lower when compared to females (1.014). The sex differences were slightly different, higher for the right hand than the left hand, implying that the 2D:4D digit ratio in the right hand is more sensitive to foetal androgens than the left hand (16),(17).
Asuku A et al., reported that the mean 2D:4D ratio in males was less than in females, and the authors also noticed that the difference was more pronounced in the right hand than the left hand when comparing the urban with rural male and female populations. Certain environmental factors influence the digit ratio during the embryonic period, which may manifest in later life, establishing such a difference in urban-rural populations (18).
According to Jaiswal A et al., the mean 2D:4D ratio in males was lower compared to females due to prenatal testosterone levels, but no significant difference was observed in the 2D:4D ratio between the right and left hands. This comparison of the 2D:4D ratio among the cisgender group is in accordance with the present study (19).
Shokri H et al., compared the 2D:4D ratio between healthy males (n=72) and males with schizophrenia (n=62) and found that there was no significant difference (p-value>0.05) between the two groups except for the right index finger length. The index finger length serves as a biomarker to assess the prognosis of schizophrenia (20).
In a study on the 2D:4D ratio in the cisgender and transgender population, Hisasue S et al., described the mean 2D:4D ratio in gender identity disorder (FtM) as 0.955 and 0.954, in the right and left hand, which is lower when compared to female controls with 0.999 and 0.979, respectively in the right and left hand. This reflects early testosterone exposure in the foetus creating an impact on the 2D:4D ratio. Control males show a lower 2D:4D ratio than control females (21). The present study also shows a lower 2D:4D ratio in control males than in control females. The comparison between male and female transgender women (MtF) and females shows a significant p-value <0.001. However, the comparison between transgender women (MtF) and males showed a p-value >0.001, which implies that the concentration of sex hormones in early foetal life decides the architecture of the human body.
According to Leinung M and Wu C, the mean 2D:4D ratio for the dominant hand in transmen (FtM) was 0.983, which was lower than in female controls (0.998) but showed a similar ratio to male controls (0.972). No difference in the 2D:4D ratio was noted between transgender women (MtF) and male controls with a p-value of 0.434, which correlates with the present study. It concluded that the gender identity of transmen (FtM) was influenced by prenatal androgen exposure, whereas for transgender women (MtF), gender identity was influenced by additional factors like prenatal stress (22).
Siegmann EM et al., observed that the mean 2D:4D ratio in both the right and left hands in MtF individuals was higher than in male controls. However, the mean 2D:4D ratios in FtM individuals were lower than in female controls in both the right and left hands. No significant results were found when comparing FtM individuals with male controls in both the right and left hands. In contrast, when comparing MtF individuals with male controls, significance was noted only in the left hand (p-value=0.049), while it was insignificant in the right hand. In the present study, the comparison between MtF individuals and female controls was significant in both the right and left hands, but with male controls, it was not significant in either hand. The results slightly differ from those of the above-mentioned authors regarding the left hand in MtF individuals’ comparison with male controls since the 2D:4D ratio in the right hand is more sensitive to foetal androgens than the left hand, and prenatal androgen influences gender identity in individuals born as males (23).
Sadr M et al., compared the mean 2D:4D ratios of transgender women and transmen with a control group of the same natal sex. The results showed that transgender women had significantly less masculinised values compared to control males, while transmen had more masculinised values compared to control women. In the present study, the comparison between transgender women and control men showed similar results, with less masculinisation and more pronounced differences on the right hand. The results possibly predict weak prenatal testosterone effects in natal males, while strong prenatal testosterone effects in natal females may be a causative factor for gender dysphoria (24).
Saglam T et al., analysed the mean 2D:4D ratios of Assigned Female at Birth (AFB-GD) and Assigned Male at Birth (AMB-GD) with male and female controls. The mean 2D:4D ratio of AMB-GD did not differ significantly from the male controls in both the right and left hand. The finger ratio in the female controls shows a significant difference on the right hand (p-value<0.001), but the ratio was found to be insignificant on the left hand. The mean 2D:4D ratio of AFB-GD shows a significant difference (p-value=0.028) from the female controls in the right hand. However, there was an insignificant difference in the left hand. In the left hand, the ratio was insignificant with female controls and showed a significant difference (p-value=0.045) with male controls. The present study on transgender women shows a significant difference (p-value<0.001) with cis females in both the right and left hands. However, on the contrary, with cis males, the p-value (0.451, 0.943) was not significant on both the right and left hands, which correlates with Saglam T et al.’s findings as the prenatal exposure of the foetal brain to testosterone level determines gender identity (25).
Vujovic S et al., observed that the mean 2D:4D ratio of MtF with control males doesn’t show any significant difference, but values were similar to control females. However, the comparison between FtM with male and female controls shows the lowest ratio in the left hand. The present study correlates with Vujovic S et al.’s findings on transgender women, which show a significant difference with female controls in both the right and left hands. However, with male controls, it was not significant in both the right and left hands. The result describes that decreased androgen exposure in prenatal life may play a vital role in MtF gender identity (26).
A significant strength of the present study is the sample collection. Out of all genderqueers, selecting transwomen was a great challenge. The methodology of recording the 2D:4D ratio by a digital scanner is more accurate. It is a non invasive method that does not cause any harm to the participants. Further studies among transwomen and other genderqueer groups with a large sample size are needed to validate the findings of the present study. In the future, further research might explore a new standard methodology to robustly capture the dermatoglyphics pattern. In the present study, only the index and ring finger (2D:4D) ratio was studied. The study of other digits’ ratios could provide additional information that may possibly fulfill the lacunae.
Limitation(s)
The larger the sample size, the more precise the results will be. The authors focused solely on transwomen, making it challenging to include a greater number of samples. When recording the finger scanning of both hands, the accuracy may be influenced by the extent of finger spreading, potentially leading to a small error.
The 2D:4D ratio indirectly predicts the foetal testosterone to estradiol ratio, enlightening us to understand and explain different personality traits. The present study concluded that transgender women’s somatic appearance falls in favour of males based on the 2D:4D ratio, which needs further extended research on the dermatoglyphics of the transgender women population to endorse the current result. India lacks considerable data regarding third genders. In view of that, the present article provides one of the crucial anthropological measurements, which will be additive to digit ratio research in India as well as be useful for forensic research.
Author’s contribution: KA: Concept, designing, data collection, interpretation of results and execution of research. DS: Designing and interpretation of results. SS: Interpretation of results and manuscript preparation.
DOI: 10.7860/JCDR/2024/74296.20338
Date of Submission: Jul 16, 2024
Date of Peer Review: Aug 08, 2024
Date of Acceptance: Sep 11, 2024
Date of Publishing: Nov 01, 2024
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. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jul 16, 2024
• Manual Googling: Aug 14, 2024
• iThenticate Software: Sep 10, 2024 (12%)
ETYMOLOGY: Author Origin
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