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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
Reviews
Full Version
Narrative Review on Prenatal, Intrapartum and Neonatal Risk Factors for Cerebral Palsy in Children
Correspondence Address :
Dr. Pranali Saurabh Thakkar,
C-504, Shreepad Celebration, Opp. Nakshatra Embassy, Near Shavion Circle, Gauravpath Road, Pal, Surat-390009, Gujarat, India.
E-mail: dr.pranalithakkar27@gmail.com
Cerebral Palsy (CP) is not a disease, however a syndrome advanced characterised by associate aberrant management of movement or posture, that seems early in life and ends up in long motor incapacity. The underlying causes of CP are still poorly understood. Many individual risk factors of CP are known, however less is understood concerning their interaction and the way they could relate to completely different pathophysiological pathways. The risk factors may be prenatal, intrapartum, neonatal or combined. Articles were searched to identify risk factors for CP, published from 2001 to 2021. A total of 43 relevant articles including randomised and non randomised controlled trials, systematic reviews and comparative studies were included in this review. From selected analysis reports, most of the studies enclosed within the review showed sturdy strength of association as a causative factor responsible for CP. From this review, it had been ended that multiple risk factors overcome the defence mechanisms and lead to CP. Although any one factor, if severe, may be sufficient to cause CP so preventive strategies and early intervention for high-risk infants are needed.
Cognitive function, Early intervention, Motor disability
Cerebral Palsy (CP) may be a non progressive condition affecting approximately 3 in 1000 newborns and it is characterised by acquired brain damage which affects motor and cognitive functions (1),(2),(3). CP is the most common cause of physical disability in childhood, with limitations that persist throughout life (4),(5),(6). CP is not an illness but a syndrome complex, characterised by an aberrant control of movement or posture, that seems early in life and results to lifelong motor disability. CP is defined as “a cluster of permanent disorders of the event of movement and posture inflicting activity limitation(s) that are attributed to non progressive disturbances that occurred in the developing foetal or infant brain”.
The motor disorders are often accompanied by disturbances of sensation, perception, cognition, communication and/or behaviour, epilepsy and musculoskeletal problems (7),(8). Incidence of perinatal and neonatal mortality has decreased, also maternal and neonatal care have undergone major changes, but the overall prevalence of CP has remained stable over the years, at between 1-3 per 1000 live births (9),(10),(11). If a neuronic loss because of brain injuries, the cortical (pyramidal) region will have spasticity, the basal ganglia (extrapyramidal) region will experience dyskinetic movements, and the cerebellum will experience hypotonia and mixed CP. Spastic CP, which accounts for 75% of cases, is the most prevalent kind. A lesser percentage of children with CP exhibit dyskinetic behaviour (12).
The underlying causes of CP are still poorly understood. Many individual risk factors of CP are known. However, less is understood regarding their interaction and the way they could relate to completely different pathophysiological pathways. The risk factors that will be antenatal, perinatal or neonatal, or postneonatal are represented in (Table/Fig 1) (13). Different areas of research are of interest over the years to spot causes of CP, and it is modified due to the development of maternal and neonatal care: as an example, the occurrence of cerebral damage due to hyperbilirubinemia has decreased dramatically in higher resource countries (14).
The purpose of this study was to review the current research on risk factors of CP for children and how the new findings can affect the content of the CP registers across the world. The research question for this study was ‘What risk factors for CP have been identified in the literature for infants?’
LITERATURE SEARCH
All the peer-reviewed full-text articles published in the English language, between 2001 to 2021, with the primary aim of identification of risk factors for CP in all birth types, were searched from various online databases including Google scholar, PubMed, Elton B. Stephens Company (EBSCO), Medline, ScienceDirect, Cumulated Index to Nursing and Allied Health Literature (CINAHL) and 182 articles were found. A 136 relevant articles were found out of 182, out of which 93 articles were excluded (i.e., three were published in languages other than English, 1-a case report, 38-included risk factors not specific to CP, 29 were articles dedicated entirely to genetic risk factors, 14 were published before 2001 and 8 were only abstracts). As a result, 43 full-text articles were identified and reviewed in this manuscript. A narrative review of all 43 articles was conducted to identify risk factors for CP.
There are several heterogeneous risk factors at focus in current research regarding CP. Studies regarding one or a few prenatal risk factors are listed in (Table/Fig 2) (15),(16),(17),(18),(19),(20),(21),(22),(23),(24),(25),(26),(27),(28),(29),(30),(31),(32),(33),(34),(35),(36). Those regarding perinatal and neonatal risk factors are listed in (Table/Fig 3) (36),(37),(38),(39),(40),(41),(42),(43),(44),(45),(46),(47),(48),(49) and similar review articles are described in (Table/Fig 4) (50),(51),(52),(53),(54),(56). Preventive strategies for CP in high-risk infants by identifying risk factors for CP are necessary. For an individual infant, it is essential to establish a diagnosis of CP or motor development as early as possible to optimise the effectiveness of rehabilitative intervention.
PRENATAL RISK FACTORS
Foetoplacental and uterine infection or inflammation will cause the initiation of preterm labour, which might cause Central Nervous System (CNS) injury and CP. Underdeveloped foetal brains are more prone to inflammation and inflammatory cytokines. These cytokines are hypothesised to be accountable for the event of Periventricular Leuckomalacia (PVL) (26),(45).
Chorioamnionitis is an infection of the chorion and amnion, the two membranes encompassing the developing foetus. It’s the foremost frequently related to maternal infection in CP. Wu YW et al., concluded that chorioamnionitis will be thought about a reason for CP. In their study, they found that chorioamnionitis is severally related to a 4-fold exaggerated risk of CP in infants (16). Chorioamnionitis could cause CP by depriving the foetus of oxygen for a while which can cause brain injury. Researches show that maternal infection and Urinary Tract Infection (UTI) is one of the causes of CP (18),(24),(26),(45). The main finding of this study was that maternal infection was related to more or less two-fold exaggerated risk of CP in each term and preterm infants. The effect of maternal infection on CP risk appears to be greater in preterm than in term infants.
Few studies showed that GA and pre-eclampsia are the reason for CP. GA appears to modify the impact of risk factors for CP, significantly pre-eclampsia, and small for GA (17),(19),(20),(21); these seems protective before 33 weeks gestation, however it is associated with an exaggerated risk of CP in term babies. Many explanations have previously been put forward to explain this counterintuitive phenomenon. Firstly, babies with cerebral damage delivered preterm to mothers with pre-eclampsia are more vulnerable to mortality. With current management, however, most babies delivered preterm attributable to severe pre-eclampsia survive. Secondly, magnesium sulfate, used in many centers for the prevention or treatment of seizures is also neuroprotective (14). Maternal age, the exaggerated risk of CP among offspring of women over the age of 35 years in one study was vital compared with offspring of women aged from 18 years to 35 years. The exaggerated risk of CP in this group might be associated with changes in uterine function seen with advancing age and the state of high-risk pregnancy and its multiple co-variates (33). In the present study, one of the articles showed that multiple pregnancies, low birth weight, and GA are causes of CP (34). Meeraus WH et al., in their study, found no association between antibiotic prescribing in pregnancy and CP (28). The distribution of cases differs substantially between twins and singletons, and the higher rate of CP in twins cannot be exclusively attributed to their low birth weight and GA (20).
INTRAPARTUM AND NEONATAL RISK FACTORS
Intrapartum risk factors as well as asphyxia and intrapartum stroke, had attracted the more range of publications, followed by genetic studies [57-62]. In general, CP is associated with complicated perinatal events, but most cases may require delivery care as well. Toxoplasmosis, other infections (varicella zoster, adenovirus, enterovirus), rubella, cytomegalovirus, herpes simplex virus, and syphilis are associated with Toxoplasmosis, Others (syphilis, hepatitis B), Rubella, Cytomegalovirus, Herpes simplex (TORCH) [63,64]. About 5% of CP cases are caused by TORCH infections (62). There has been some evidence that birth asphyxia contributes to CP (27),(47),(36),(51),(53). Between 4 and 9 million infants in developing countries suffer from birth asphyxia annually (65). Neonatal asphyxia accounts for 20%-40% of all neonatal deaths every year (15). There was also a strong association between birth asphyxia and CP, which is supported by recent reports identifying birth asphyxia in clinical chorioamnionitis (16).
Although CP is associated with preterm deliveries, the majority of infants with CP (75%) are born after 36 weeks. It is hypothesised that delivering a foetus with cerebral abnormalities is also associated with physiological changes that trigger labour as foetuses with cerebral abnormalities tend to be delivered either preterm or post-term (66). Gurbuz A et al., in their study concluded that low birth weight is one in every common causes of CP. The only significant perinatal risk factor was the neonatal weight of <2500 grams (39).
Few articles showed that low APGAR score, placental abruption, and vaginal breech delivery can be one of the causes of CP (15),(19). Low APGAR scores were highly associated with CP, and although low scores may reflect a compromise of different origins [15,19]. Five-minute APGAR scores below 4 at term in no malformed neonates are often associated with acidemia at birth, indicating intrapartum hypoxia, and with neonatal encephalopathy (19). Instrumental delivery and emergency caesarean delivery were both associated with CP (40).
A few causes supported by different articles are Meningitis, PDA, and PVL, IUGR; which is one of the causes of CP. PVL is considered the result of different causal pathways leading to CP in preterm neonates and is better interpreted as a proxy measure of CP rather than a risk factor, although a minority of children with PVL do not develop CP (41). The most common cause of CP in preterm newborns is PVL, a disorder in which the white matter around the ventricles of the brain is undeveloped. Intraventricular Haemorrhage (IVH), which is mostly linked to prematurity, is brought on by the infant’s developing blood vessels’ susceptibility to rupture. Other areas of the brain may experience ischaemia or PVL due to IVH (67). One study demonstrates that hypoxia and the neck cord are two causes of CP. Most cases of suffocation were caused by cord and placental problems. In one study, the chord around the neck was significantly associated with an increased risk of spastic CP, while placental infarction was more strongly connected with an increased risk of spastic quadriplegia (42).
Collins MP et al., showed that there was a strong relationship between exposure to a modest degree of hypocapnia and the risk of developing CP (37). One study showed that meningitis and encephalitis are also the cause of CP and they also found that mature babies had prenatal brain atrophy or hypoxic-ischaemic cerebral lesions. Immature babies ≥33 week showed prenatal porencephaly or encephalomalacia after asphyxia. Premature babies ≤32 week had cystic periventricular leucomalacia or cerebral haemorrhage (38).
A sizable number of CP cases are due to acquired factors such meningoencephalitis, seizure disorders, and newborn jaundice (51). One of the risk factors for CP is also epilepsy. A dyskinetic or bilateral spastic kind of CP, as well as other associated deficits, was more common in children with epilepsy, according to one of the studies, the author discovered (47).
All studies that have examined these risk factors for babies have found them to exist, and targeted prevention efforts should be made to address them; limiting the number of IVF embryo transfers, quitting smoking while pregnant, screening for and treating asymptomatic bacteriuria during pregnancy, and antiplatelet medications to prevent pre-eclampsia are some specific methods to lower the likelihood of premature birth (68).
Reducing the risk of premature delivery and other preventative measures by being aware of the risk factors are interventions that show promise for lowering the prevalence of CP. Since infancy and early childhood are times of maximum neuronal plasticity and when therapeutic interventions have the best chance of long-term effectiveness, it is important to diagnose CP or developmental delay in infants as early as possible to optimise the effect of the intervention. Therefore, the earlier we begin the intervention, the greater the impact on motor and cognitive outcomes (69),(70),(71),(72).
Preventive measures and early intervention for infants who are at high risk for CP are necessary because the condition includes a variety of aetiologies and risk factors, including prenatal, perinatal, and neonatal causes. Although the existence of many risk factors that override the body’s defence mechanisms may exacerbate CP, although any one risk factor, if significant, may be sufficient to cause CP. Patients with brain malformations are a unique population that requires additional research to determine the risk factors that may contribute to it, including environmental variables, genetic predisposition, and other prenatal or perinatal events. To discover the best preventative measures to use with these patients, more research is required.
Author, Dr. Pranali Saurabh Thakkar expresses immense pleasure and satisfaction in presenting this review. Author would like to express sincere gratitude to the advisor, Dr. Madhavan Iyengar for the guidance during the review. Author would wish to avail herself of this opportunity and, express a sense of gratitude and to author’s husband, parents and family for providing with all kinds of support. Author expresses heartily thanks to all the colleagues and friends.
DOI: 10.7860/JCDR/2023/56550.17671
Date of Submission: Mar 24, 2022
Date of Peer Review: Jun 18, 2022
Date of Acceptance: Oct 20, 2022
Date of Publishing: Mar 01, 2023
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? No
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. No
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Apr 02, 2022
• Manual Googling: Sep 23, 2022
• iThenticate Software: Oct 18, 2022 (22%)
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