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

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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)
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.
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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.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2012 | Month : May | Volume : 6 | Issue : 4 | Page : 586 - 589

Diffusing Lung Capacity in Swimmers and Non-swimmers - A Comparative Study

Vaithiyanadane.V, Sugapriya.G, Saravanan.A, Ramachandran.C

1. Department of Physiology 2. Department of Physiology 3. Department of Physiology 4. Department of Physiology NAME OF DEPARTMENT (S)/INSTITUTION(S) TO WHICH THE WORK IS ATTRIBUTED: SRM Medical college Hospital and Research Center, Kattankulathur, India.

Correspondence Address :
Sugapriya.G
Department of Physiology, SRM Medical college Hospital
and Research center Kattankulathur

Abstract

Background: The main function of the lung is gas exchange, which can be assessed in several ways. A spirometer measures the flow and the volumes of the inspired and the expired air, but it does not provide information about the gas exchange. Taking an arterial blood gas sample is the most simple method which can be used to assess the pulmonary gas exchange.

Aims and objectives: To compare the diffusing lung capacity among swimmers and non-swimmers and to test the hypothesis that the ventilatory drive is modified by swimming.

Materials and methods: In this study, 20 subjects who were aged between 19-35 years, with 2-5 years of swimming experience were selected and 20 controls who were in the same age group, at the SRM Medical College were included after obtaining the institutional ethical clearance and their consent. An ‘Easy one pro Spiro meter’ was used to find out their diffusing lung capacities.

Results: The parameters were analyzed statistically by using the Students ‘t’-test. There was no significant difference in the age, weight, height and the BMI between the swimmers and the non-swimmers. But there was a significant difference in the mean and the standard deviation of the diffusing lung capacity parameter. The mean and the standard deviation of the swimmers and the non-swimmers were (23.17±6.575) and (14.72±2.912), with a p-value of <0.000, which was more significant.

Conclusion: The results showed a significant difference in the diffusing lung capacity in the swimmers as compared to the non-swimmers, since the O2 utilization for the muscle was higher in the swimmers. The swimmers had a greater diffusing lung capacity than the non-swimmers, probably due to an increase in the number of alveoli, which acted as a predictor of their performance.

Keywords

Swimmers, Spiro meter, DLCO

Introduction
Our human body is an amazing machine in which perfectly coordinated events occur simultaneously. These events allow complex functions such as hearing, seeing, breathing and informationprocessing, to continue without one’s conscious effort. If anyone performs any activity like swimming, he will be successfully shifting his body system from rest to an active state. If he continues this activity several times, then his body gets adapted to that particular activity in a better way. Swimming is a difficult process which makes the muscle fit. If anyone wants to be a swimmer, his or her physical activity level should be high as compared to that of the non-swimmers. Some physiological changes take place in the human body when a person continuously swims. Swimming may be looked upon as a self imposed change in a self environment (1). Swimming practically engages all the muscle groups. Hence, the O2 utilization for the muscle is higher in swimmers. The water pressure on the thorax makes respiration difficult. Breathing is not as free during swimming, as in most other types of exercise, because the respiration during competitive swimming is synchronized with the swimming strokes (2).

Competitive swimmers require a high aerobic capacity to support the sustained performance of severe exercise, and the measurements of the maximal rate of the oxygen uptake which a swim- Physiology Section mer can sustain during exercise provides a useful index of physical fitness. The maximum oxygen uptake of swimmers has been determined under various conditions [3,4]. The breathing (respiratory) muscles which are composed of the diaphragm, the external and the internal intercostals, the parasternal, sternomastoid and the scalene, the external and the internal oblique and the abdominal muscles are the vital organs in mammals by which oxygen is delivered to the red blood cells and concomitantly, carbon dioxide is removed and expelled into the environment. These play a crucial role during exercise [5,6]. Since athletes take thousands of breaths during the competition, like all other skeletal muscles, the respiratory muscles also need a required amount of oxygen for them to work properly (6). Formerly, it was widely known that the respiratory system did not limit the exercise performance in humans (Dempsey, 1986; Leith and Bradley 1976). However, many researchers stated that the respiratory system could impact the strength and the exercise performance in healthy humans and highly trained athletes [7-13], notably at high intensities [14,15]. The general aspect of the gas exchange A main function of the lung is to establish gas exchange between the body tissues and the surrounding air. O2 is taken up and CO2 is eliminated. This process of gas exchange can be subdivided into three stages.

1. Ventilation, which is the mechanism by which the alveolar gas is intermittently refreshed with ambient air. As a result, the O2 concentration in the alveolar gas is kept high and the CO2 concentration is kept low. 2. Alveolar-capillary diffusion, which is the passage of gases across the blood-gas barrier by passive diffusion. 3. Perfusion, which involves the distribution of blood in the lungs and its removal from the lungs by the blood circulation process (16). Fick’s law: A diffusion process in one medium by which molecules are transferred from a place with a high concentration to a place with a low concentration. Henry’s law: In the lungs, diffusion occurs between a gas and a liquid phase. The concentration in a liquid is a function of the solubility of the gas exchange in the liquid and the pressure of the gas, since the quantity of the dissolved gas is proportional to the pressure.

The diffusion capacity of the lung for carbon monoxide (DLCO) is a standard test in the pulmonary function laboratory. The DLCO is used in the assessment of restrictive as well as obstructive pulmonary diseases, and it is an indicator of the disease severity. In chronic obstructive pulmonary disease (COPD) and in diffuse parenchymal lung diseases (DPLD), the DLCO is a strong predictor for de-saturation during exercise [17,18]. The carbon monoxide (CO) diffusing capacity (DLCO) provides an objective measurement of the lung function. It is defined as the lung’s ability to take up an inhaled non reactive test gas such as carbon monoxide (CO), which binds to haemoglobin. CO will bind to haemoglobin with such a high affinity; that virtually all of the CO will reach the alveolar space. This will cause the carbon monoxide to cross the alveolar air-blood barrier, to reach a red cell that will bind to haemoglobin and be removed with the exhaled gas. The carbon monoxide diffusing capacity (DLCO) is the rate of the uptake of carbon monoxide (CO) per driving pressure of the alveolar CO. The simplified equation is: DLCO = VCO/PACO VCO = the uptake of CO (milliliters per minute) PACO = the mean alveolar pressure of CO (milliliters of mercury) This test can be used for a wide variety of diseases, because it is relatively easy to measure or estimate the two determinants. The component resistances to DLCO include: a. The pulmonary membrane (the pulmonary tissue and the plasma layer). b. The red blood cell resistance, which is a function of the rate of CO uptake by haemoglobin and the pulmonary capillary blood volume ( Bone RC et al., (19) ; Goldman L et al., (20).

Material and Methods

This comparative study on the diffusing lung capacity between swimmers and non swimmers observed subjects who were aged between 19-35 years. This present study was conducted in the Department of Physiology, SRM Medical College and Research Centre, Kattankulathur, after ethical clearance was obtained from the ethics committee and informed consent was obtained from the subjects.

The total sample size was 40, of which 20 subjects were swimmers with 2-5 years of experience and 20 subjects were non-swimmers without any swimming experience, who were equally divided into two group A (swimmers) and group B (non-swimmers). An Easy one pro Computerized Spiro meter which was attached to a carbon monoxide cylinder was used to find the diffusing lung capacity of the subjects. A written consent was taken from the subjects and they were asked to breathe as per the instructions, to record the parameters. Smokers and those with a history of abdominal or thoracic surgery, pulmonary, cardiac disorders, and neuromuscular disorders were excluded from the study. The procedure which was used for obtaining the diffusing lung capacity parameter was; the subject’s nostrils were closed by using a nose clip and he/she was asked to hold the sensor straight in front of his or her mouth without taking the mouth piece into the mouth as yet. Then, the subjects were asked to do tidal breathing and after 3 or 4 breaths, they were instructed to fully exhale, during which the Activate button (the valve automatically closes at the end of the exhalation) was pressed. Then, the subjects were asked to fully inhale the gas and to hold their breath for 10 seconds. After 10 seconds, the valve opened and the subjects were asked to exhale quickly and to continue with tidal breathing till the end of the test. The parameters were statistically analyzed by using the paired ‘t’- test.

Results

The anthropometric data for DLCO There was no significant difference in the age, sex, height, weight and the BMI between the swimmers and the non-swimmers. The diffusing lung capacity data The mean and the standard deviation of DLCO in the swimmers were 23.17±6.575, whereas in the non-swimmers, they were14.72±2.912. There was a significant increase in these values in the swimmers as compared to the non-swimmers, with a p-value of 0.000.

Discussion

In our study, we also found that the DLCO was significantly higher in the swimmers as compared to that in the non-swimmers. Our results were similar to the results of few other studies, though only very few studies had assessed the DLCO in swimmers. In a study which was conducted by Paul Vaccaro et al., (21) on the physiological characteristic of young well-trained swimmers, the DLCO was found to be significantly higher as compared to that in non swimmers. J Armour et al., (22) found that the pulmonary diffusing capacity (DLCO) was highest in swimmers, while all the other indices of the lung function, which included pulmonary distensibility, elastic recoil and diffusion co-efficient were similar between the swimmers and the non-swimmers. These findings suggested that the swimmers may have achieved greater lung volumes than the non-swimmers, not because of the greater inspiratory muscle strength, or the differences in the height, fat free mass or the alveolar distensibility, but by developing physically wider chestswhich contained an increased number of alveoli, rather than alveoli of increased sizes. In a study which was conducted by Magel John K et al.,(23) on young trained Norwegian swimmers, the DLCO at rest in the trained swimmers was significantly higher as compared to that in the non-swimmers. The maximal values for the DLCO in the trained swimmers averaged approximately 51% above the resting level, while the increase was significantly less (35%) for the untrained subjects.

Conclusion

Globally, very few studies were conducted and documented between the swimmers and the non swimmers by using different methods and standardized criteria. In this study, especially students were selected for both the groups and a spiro meter was used to determine the diffusing lung capacities. Statistically, the parameter (DLCO) was analyzed and compared by using the ‘paired t’-test. The results which were obtained from this study showed a significant difference in the mean and standard deviation. The means of all the parameters were significantly higher in the swimmers; so we conclude that the swimmers had greater diffusing lung capacities as compared to the non swimmers due to the increased inspiratory muscle strength and the increase in the number of alveoli. More information can be obtained if this study is continued for a longer duration.

Acknowledgement

I sincerely thank my guide, the head of the department and my colleagues for their guidance and constant support throughout my study.

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