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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
Radiological Appearance of Molars: Do They Consistently Identify Babies of 33-36 Weeks Gestation?
Correspondence Address :
Dr. Jacob Puliyel St Stephens Hospital, Tis Hazari, Delhi, India - 110054. E-mail: puliyel@gmail.com
Background: Gestational age is calculated from the date of the last menstrual period (LMP) may not be accurate when the cycle is irregular. In a previous study on small sample of European babies, the appearance of the cusps of the deciduous molar teeth on radiographs was found to be useful for determining the gestational age. The accuracy of this method was not affected by intra-uterine malnutrition. We did this prospective study on a large sample of newborns in India to validate the findings.
Materials and Methods: Chest radiographs taken within the first 3 days of life – when they included the mandible – were studied against gestational age. Dates as per LMP, confirmed by either ultrasound examination during pregnancy or by Ballard’s scoring after birth, were the standard against which tooth age was validated.
Results: The area under the receiver operating characteristic (ROC) curve for the 1st molar was 0.933 (95% CI: 0.900 to 0.966) and that for the 2nd molar was 0.952 (95% CI: 0.920 to 0.983). Accuracy was only marginally affected by intrauterine malnutrition.
Conclusion: Tooth age may be used to estimate gestational age. Like the findings of ophthalmic examination at birth, tooth age is only marginally affected by intrauterine malnutrition.
Ballard’s score, Antenatal ultrasound age, Bone age, Tooth age, Small for gestational age
Introduction
Neonatal mortality and morbidity varies according to the gestational age (1),(2). Accurate estimation of gestational age is important for correct management of the infant (3). Several methods for estimating gestational age are available (4). Most often, gestational age is calculated from the date of the last menstrual period (LMP) (5). When there is uncertainty about this on account of an irregular cycle (6),(7), antenatal ultrasound (8), bone age (9), and clinical examination of the infant for physical and neurological maturity (10) are used. These too have their drawbacks. Antenatal ultrasound measurements are biased when fetal growth is hampered (11). Bone ossification is also affected by various factors such as fetal malnutrition and intra-uterine hypothyroidism (12),(13). Post-natal clinical examination by Ballard’s scoring system has been found to give the best estimate of gestational age (14). Ballard’s scoring is however difficult to perform in sick preterm infants and in small-for-gestational-age (SGA) infants, as the general appearance is often indistinguishable from that of true prematures (15). Ophthalmic examination also yields clues regarding the true gestational age in SGA babies (16),(17). Nevertheless, estimating gestational age in sick preterm infants, especially those who are SGA, is a challenge.
In 1972, Kuhns et al., (18) studied the calcification crowns of the 1st and 2nd deciduous molars. Fifty-two newborn infants were evaluated. No 1st molar appeared before 33–34 weeks of gestation and no 2nd deciduous molar was radiographically visualized before 36–37 weeks; they were invariably found after that age. Accuracy of aging by this method was unaffected by intra-uterine growth retardation. However, the sample size in that study was small.
A large number of Indian babies are born SGA (19),(20). We undertook this prospective study to evaluate the usefulness of this method for estimating gestational age in this population with a large incidence of SGA babies.
All newborn babies admitted in the neonatal nursery were eligible for inclusion in the study. Data was collected between 1st November 2006 and 31st December 2007. The LMP of the mother and antenatal ultrasound findings were noted. Gestational age assessment by the new Ballard’s scoring system is done routinely within 48 hours of birth in the nursery. Babies on ventilator and sick neonates are not subjected to this assessment. A baby was included in the study if he or she had a chest radiograph done within 72 hours of life and if the radiograph showed the mandible. No infant underwent radiographic examination solely for the purpose of this study. A priori, a family history of hypodontia was an exclusion criterion. Written informed consent was taken from the parents for gestational age assessment by the various methods. The study was approved by the hospital research board.
At the time of discharge, all radiographs of the child were assessed by one of the authors (RS) for calcification cusps of the 1st and 2nd molar teeth. This author was blind to the gestational age of the baby. A distinct line of calcification involving the cusps of a molar was looked for in the radiographs (Table/Fig 1), (Table/Fig 2), and (Table/Fig 3).
To overcome any possible error in LMP due to mistaken dates and irregular cycle length, only babies whose gestational age by LMP was confirmed by at least one other method (antenatal ultrasound estimation or Ballard’s scoring) were included in the study.
There were 217 babies who had a suitable radiograph of the mand-ible during the study period. Of these, 182 had suitable assessment of gestational age (LMP age that was confirmed by either Ballard’s scoring or ultrasound age). These 182 infants were therefore enrolled in the study. We used receiver operating characteristic (ROC) to look for the predictive ability of the appearance of 1st and 2nd molar teeth for estimation of gestational age. Infants were further grouped as being appropriate for gestational age (AGA) or SGA according to whether their weight at birth was above or below the 10th centile for age. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy in SGA and AGA babies were calculated separately using 2 × 2 tables.
(Table/Fig 1) shows the demographic characteristics of the study population. The gestational age ranged from 25 to 43 weeks, with the mean and median being 34 weeks. According to the study criteria, 16% were SGA.
(Table/Fig 4) and (Table/Fig 5) show the ROC curve for the 1st and 2nd molars, respectively. The area under the curve for the 1st molar was 0.933 (95% CI: 0.900 to 0.966) and that for the 2nd molar was 0.952 (95% CI: 0.920 to 0.983). For the 1st molar, the sensitivity was 96%, specificity 76.5%, PPV 88.4%, NPV 92%, and accuracy 89.5% in AGA babies (Table/Fig 2) ; in SGA babies, the sensitivity was 86.6%, specificity 88.8%, PPV 92.8%, NPV 80%, and accuracy 87.5% (Table/Fig 3) . For the 2nd molar, the sensitivity was 96%, specificity 90.6%, PPV 87.5%, NPV 97.1%, and accuracy 92.8% in AGA babies (Table/Fig 4); the sensitivity was 75%, specificity 100%, PPV 100%, NPV 94.7%, and accuracy 95.4% in SGA babies (Table/Fig 5) .
(Table/Fig 4) shows the mean age of appearance of the 1st and 2nd molar teeth in AGA and SGA babies. The mean age of appearance of the 1st molar was 33.7 weeks in AGA babies and 35.45 weeks in the SGA group. The mean age of appearance of the 2nd molar was not very different in the two groups (38.12 weeks in AGA and 38.2 weeks in SGA babies). (Table/Fig 6),(Table/Fig 7),(Table/Fig 8),(Table/Fig 9),(Table/Fig 10),(Table/Fig 11).
We found that age at appearance of the deciduous molars on radiographs was useful for assessment of gestational age. The area under the ROC curve of 0.933 and 0.952 for the 1st and 2nd molars, respectively, suggests that this method has excellent discriminative ability in age assessment. Our findings using ROC curves confirms the findings of Kuhns et al., (18) This is arguably the largest study of gestational age assessment using tooth age. We used dates as per LMP, confirmed by another method (ultrasound estimation of gestational age or Ballard’s scoring), as the gold standard against which tooth age was compared. Kuhns et al., (18) had studied only European Caucasian infants with gestational age of 26–42 weeks. Our data shows that their findings also hold for Asian children. The study cohort of Kuhns et al. included 11 SGA babies; 10 of them had normal tooth mineralization and they had concluded that tooth age was not affected by being SGA. Our sample contained 29 SGA babies. Statistical analysis was done by comparing the SGA babies to AGA babies using 2 × 2 tables. The accuracy was only marginally different (±2 weeks) in the two groups. Kuhns et al. found tha tooth mineralization was consistent with gestational age in trisomy 21, retarded in trisomy 13-15, and accelerated by 5 weeks in trisomy 18. Our cohort did not include any babies with chromosomal aberrations. In a case of superfetation, where one of the twins was 32 weeks and the other 36 weeks at birth, we found that tooth age estimation, along with the Ballard’s score and ophthalmic examination, helped to corroborate the gestational age disparity that was first noticed during antenatal intra-uterine ultrasound examination (21). To the best of our knowledge, there are no other large studies with which we can compare our findings. It would appear that tooth age is a reliable method for the estimation of gestational age in infants between 33 and 37 weeks of gestation.
Date of Submission: Jan 03, 2012
Date of Peer Review: Apr 01, 2012
Date of Acceptance: Apr 02, 2012
Date of Publishing: June 22, 2012
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