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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)
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.
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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.
On April 2011

Important Notice

Original article / research
Year : 2011 | Month : June | Volume : 5 | Issue : 3 | Page : 538 - 541

Sexual dimorphism in the Humerus : south Indians


Department of Anatomy, S. N. Medical College Bagalkot, Karnataka Department of community medicine , S. N. Medical College Bagalkot, Karnataka

Correspondence Address :
Sanjeev Kolagi
Associate professor,
Department of Anatomy, S N Medical College, Navanagar,
Bagalkot-587101,Karnataka State
Phone- 09731798355


The present study aimed to detect the possibility of sex discrimination from the humeral measurements in south Indians. One hundred normal right humeri were taken from one hundred cadavers (54 males and 46 females) who were above 20 years of age and who belonged to the south Indian population. Six measurements of the maximum length, vertical head diameter, midshaft circumference, minimum midshaft diameter, maximum midshaft diameter and epicondylar breadth were taken from each humerus. The measurements were statistically analyzed.


Sexual dimorphisum, Humerus, Osteometry

The facility for personal identification, at present, is making rapid progress because of the development of the polymerase chain reaction (PCR) and stereolithography (1) (2).

The determination of sex is a very important component of any human skeletal analysis. Sex estimation in a complete human skeleton is usually easy by the observation of morphological traits (3).

Sex discriminatory functions which are obtained for each bone are very useful in mass disasters and criminal cases of multiple human burials, where charred bodies and scattered, mixed or incomplete remains are recovered. Since the osteometric methods for the determination of sex from the skeleton are population specific, researchers from around the world have conducted studies to establish group- specific standards of assessment (4).

Many bones have been previously used for the identification of sex, and such studies emphasize that sexual dimorphism starts to appear after puberty.(5) The humerus has rarely been tapped as a site for sex determination, though it has often demonstrated an even greater accuracy than other long bones such as the femur. (6)(7) Therefore, the purpose of this research was to establish osteometric standards for the determination of sex from the humerus in south Indians.

Material and Methods

The present work was carried out on 100 right humeri (54 males and 46 females) which belonged to the south Indian population. They were collected from the anatomy departments over 3 years. The bone samples were dissected and extracted from adult cadavers.
Samples with any pathological changes, fractures or the nonunion of the epiphysis of the head were excluded.

The collected bones were socked in a saturated solution of sodium chloride for 4- 6 weeks, and were then boiled in water with a pinch of sodium carbonate for 20-25 minutes. All adherent soft tissues were removed and the bones were dried for 2 days (8).
Six dimensions were taken for each humerus (to the nearest millimeters) by using an osteometric board (Table/Fig 1), a sliding caliper (Table/Fig 2) and a steel tape. The measurements included maximum length (V1), vertical head diameter (V2), midshaftcircumference (V3), minimum midshaft diameter (V4), maximum midshaft diameter (V5) and epicondylar breadth (V6) (Table/Fig 3) The Student’s t test was used to determine the mean standard deviation (SD), standard error (SE) and the variance for each variable in both the sexes. The T and P values were estimated, and the level of significance was set at 0.05. The data were also statistically analyzed by using the main from the SPSS program, version 6 (1988)(9).

The distance between the sex means (d/s) was also determined from the ratio of the mean difference and the mean standard deviation, to demonstrate the overlap between the male and the female samples.(10) The following formula was used: d/s= (Xm-Xf) √ (nM s2 M + nF s2 F) / (nM + nF) (Xm-Xf= means, nM, nF= examined samples; s2M, s2F variance in two samples). The mean difference (Xm-Xf) is the difference of the means of the males and females. Mean standard deviation is the square root of the ratio between the sample variance (males and females) and the total sample size. d/s was calculated to demonstrate the overlap between the male and the female samples.

The cut off level, the value which maximized the sum of the sensitivity and specificity, was determined for each variable by using the Receiver Operating Characteristic (ROC) curve (11). Various combinations to the measurements from V1 to V6, were also analyzed by using the ROC curves. Then, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and the accuracy for each variable were detected separately and in combination.

The results of the descriptive statistical analyses are represented in (Table/Fig 1) revealing the mean, standard deviation, standard error and the variance of each variable. The t values for comparisonbetween the males and females and their significance are given. Also, the distance between the sex means (d/s) were recorded.

(Table/Fig 4) shows that the mean values of males were significantly higher than those of the females in all measurements (p<0.001). The standard deviations denoted that males exhibited more variability than females in all the variables.

The maximum length (V1) was the measurement with the greatest sex difference (d/s=2.07), followed by the midshaft circumference (V3) with d/s= 1.83, the minimum midshaft diameter (V4) with d/s= 1.77, epicondylar breadth (V6) with d/s= 1.74 and, the vertical head diameter (V2) with d/s= 0.47. The mean values of the six measurements in males and females are illustrated in (Table/Fig 5). The efficacy of the sex determination from each variable was tested by using the ROC curves to detect their cut off values. Measurements which were equal to or higher than the cut off levels indicated a male individual and lower values indicated afemale individual. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and the accuracy for each variable are shown in (Table/Fig 6).


The results revealed that the measurements of males weresignificantly higher than those of the females (P<0.001). The maximum length was the most discriminating variable in sex determination, with a 90% rate of accuracy, followed by midshaft circumference (86%) and the minimum midshaft diameter (82%). A combination of the two variables revealed that the minimum midshaft diameter with the epicondylar breadth gave the highest rate of accuracy for correct sex prediction, with accuracy rate of 88%. The results of this study can help in the prediction of sex from the humerus in south Indians, when other human remains which are suitable for sex determination, are not available.

The maximum length (V1) was the measurement with the greatest sex difference (d/s=2.07), followed by the midshaft circumference (V3) with d/s= 1.83, the minimum midshaft diameter (V4) with d/s= 1.77, epicondylar breadth (V6) with d/s= 1.74 and, the vertical head diameter (V2) with d/s= 0.47. The mean values of the six measurements in males and females are illustrated in (Table/Fig 7). The efficacy of the sex determination from each variable was tested by using the ROC curves to detect their cut off values. Measurements which were equal to or higher than the cut off levels indicated a male individual and lower values indicated afemale individual. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and the accuracy for each variable are shown in (Table/Fig 6).

(Table/Fig 6) shows that the accuracy of the sex measurements ranged from 58% to 90%. The maximum length (V1) was the first for sexual dimorphism, with the highest accuracy rate for sex prediction (90%). Midshaft circumference (V3) came next with an accuracy of 86%, followed by minimum midshaft diameter (V4) with an accuracy of 82%, maximum midshaft diameter (V5) with an accuracy of 80%, epicondylar breadth (V6) with 74% accuracy and finally, vertical head diameter (V2) with 58% accuracy. Also, from Table (2), it is clear that maximum length was the most sensitive variable for the identification of the male individuals (88.9%) and that it also had the highest rate of negative predictive values (87.5%) . It was followed by epicondylar breadth (sensitivity = 88.9% and NPV = 85.7%). Also, maximum length was found to be the most specific variable for the determination of the female sex (91.3%) and it also had the highest rate of positive predictive value (92.3%).

A variety of combinations between each of the two different variables were tested in order to make them more useful and these are shown in (Table/Fig 7).

It was obvious that the combination between V1 and V2, V2 and V6, V3 and V6 and V5 and V6 gave 100% sensitivity to themale sex and 100% negative prediction for females. Meanwhile, the combination between V4 and V6, V1 and V3 and V1 and V4 gave the highest rate of accuracy (88%). This is followed by the combination between V1 and V5 and V1 and V6 (86% each). The combination between V2 and V4 gave the lowermost rate of accuracy (74%).


Sex determination is the first essential step for positive identification when a decomposed body is recovered. It is essential to identify sex from different bones of the body, other than the skull or the pelvis. Many studies have set osteometric standards for sexual dimorphism.(4) In addition, populations have different morphological and metric manifestations in both the sexes (12). Therefore, it is necessary to have population specific standards from skeletal collections (13).This study aimed to determine sex by using different measurements of the humerus which belonged to south Indians. All the cases in this study were above 20 years of age, as this was the age of the epiphyseal union of the head of the humerus and its shaft, with no further growth in the bone length (5).

The results have revealed that the mean values of the male measurements were significantly higher than those of the females. For example, the mean value of the maximum length (V1) was 32.10±1.58 and 28.95±1.45 in males and females respectively. The sexual difference of the humeral measurements was previously discussed by Iscan et al.(14), who studied the sexual dimorphism of the humerus among the Chinese, Japanese and the Thai populations. They found that the mean values of V1 were 31.37±1.646 and 28.36±1.368 in the Chinese, 29.74±1.042 and 27.69±1.71 in the Japanese and 30.06±1,565 and 27.89±1.367 in the Thai populations. The sex difference in the humeral measurements was explained by Black(15), who proposed that differential bone remodeling exists between the males and females, in addition to the development of more cortical bone during adolescence in the males.

The present study revealed that the maximum length (V1) was the measurement with the greatest sex difference (d/s= 2.07). The reliability of sex determination from each variable was tested by the analysis of the ROC curves and the maximum length (V1) was found to be the most sensitive one (88.9%) with the highest rate of accuracy (90%). This was followed by midshaft circumference- V3 (86% accuracy) and minimum midshaft diameter- V4 (82% accuracy). On the contrary, Iscan et al. (1998)(14) found that the most effective single dimension, as determined by the direct discriminate analysis, was the vertical head diameter (V2) in the Chinese (81%) and epicondylar breadth (V6) in the Japanese and the Thai populations (90% and 93% respectively). Also, Wu (1989) (6) reported the greatest dimorphism in the proximal and distal bone dimension during his study on the northeastern Chinese population. He found that the humeral head diameter was the most common sex discriminator (84%).

Gray and Wolfe (1980)(16) stated that stature based sexual dimorphism peaks in societies that are at the extremes of protein consumption, both high and low. In addition, DiBennardo and Taylor(17) suggested that shape measurements are of major significance for the correct diagnosis of sex, because the functional demands of weight bearing and musculature affect the circumferential measurements more than the length. Kranioti EF, and Michalodimitrakis M(18) studied 168 left humeriby the osteometric method and they found 92.3% accuracy in determining the sex. They found that the single most effective (89.9%) dimension was the vertical head diameter of the humerus. Robinson MS and Bidmos MA(19) got a 72-95.5% accuracy in their study on the skulls and humeri of South Africans (Europian Deescent).

A combination of the more sex differentiating measurements provided a higher rate of accuracy. A combination of the minimum midshaft diameter and epicondylar breadth (V4 and V6) gave the highest rate of accuracy (88%) and this seemed to be the most reliable one. This was followed by a combination of the maximum length and midshaft circumference (V1 and V3) and a combination of the maximum length and the minimum midshaft diameter (V1 and V4), with an accuracy rate of 88% for each. On the contrary, Iscan et al,(14) selected four variables for the Chinese and Japanese and three variables for the Thais. The only dimensions which were common to all the groups were epicondylar breadth and vertical head diameter, while maximum length was present as a factor only in the Chinese. They found that the highest rate of accuracy was 86, 8% in the Chinese, 92.4% in the Japanese and 97.1% in the Thais.

The degree and the distribution of sexual dimorphism vary both within and between the different regions. Therefore, most skeletal biologists agree that the interpopulation difference necessitates the development of regionally specific standards for the identification of sex. This study underscores the need for medicolegal investigations and also for the study of population affinities and factors which affect bone configurations.

It must be noted that the patterns of sexual dimorphism differ between populations and that the results which were obtained, could not have similar accuracy if they were applied to different ethnic groups. This study confirms the reliability of sex identification from the humerus and the reported results can be considered as a valid support for the medicolegal investigations which involve the skeletal remains of south Indians.


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