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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
Comparison of Arterial Stiffness among Prehypertensive and Normotensive Subjects using Photo Pulse Plethysmography: A Pilot Study
Correspondence Address :
Dr. P Jeyashree,
Plot 22, Flat F1, Aruna Chaleshwarar Arulagam, Sastri Street, Velachery, Chennai-600042, Tamil Nadu, India.
E-mail: drjshree02@gmail.com
Introduction: Increased arterial stiffness is a marker of Cardiovascular Disease (CVD), even before clinical signs and symptoms become evident. Hypertension is an established risk factor for CVD. However, recent studies have revealed increased arterial stiffness even among prehypertensives. Photo Pulse Plethysmography (PPG) is an efficient non-invasive, and cost-effective technique to measure arterial stiffness. Studying arterial stiffness using PPG can serve as a surrogate marker of Cardiovascular (CV) risk among prehypertensives.
Aim: To compare arterial wall stiffness among prehypertensives and normotensives using PPG.
Materials and Methods: This pilot study was conducted at the Sri Ramachandra Institute of Higher Education and Research, Chennai, TamilNadu, India from December 2022 to February 2023. The study population included 10 non diabetic prehypertensives and 10 normotensives, aged between 30-50 years, with normal lipid profiles. The peripheral pulse was recorded using a PPG module and digitised using AUDACITY software. The Arterial Stiffness Index (SI) was calculated and compared between the two groups. The correlation between anthropometry and arterial SI was also determined. Pearson’s correlation test was used to assess the association using Statistical Package for Social Sciences (SPSS) version 24.0.
Results: The SI was found to be higher in prehypertensives compared to normotensives, and this difference was statistically significant (p-value=0.04). SI showed a positive correlation with increasing Blood Pressure (BP) and anthropometric variables (Body Mass Index [BMI] and Waist-Hip Ratio [WHR]; r=0.2 and r=0.15, respectively); however, no significant relationship was observed among these variables.
Conclusion: This study concludes that the SI, an important CV risk marker, shows a significant increase in prehypertensive subjects compared to normotensive subjects. However, SI showed mild positive correlation with BP and other anthropometric measurements, though not statistically significant.
Anthropometric measurements, Cardiovascular disease, Stiffness index
According to the World Health Organisation (WHO), 1.28 billion adults between 30-79 years worldwide have hypertension, with two-thirds of them living in low and middle-income countries (1). The overall prevalence of hypertension in India was 29.8%, and the prevalence of prehypertension among young adults was high at 45.2% (1). Additionally, the prevalence of prehypertension among adults in South India was 55%, while in North India it was 40.8%, indicating an alarming increase (2),(3).
In 2003, the Joint National Committee (JNC) 7 on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure introduced the term “Prehypertension” (4). Prehypertension is defined as individuals with a Systolic Blood Pressure (SBP) of 120-139 mmHg, and/or Diastolic Blood Pressure (DBP) of 80-89 mmHg. Prehypertension carries an increased risk of converting to full-blown hypertension and cardiovascular events if left unnoticed (5). The sustained increase in blood pressure promotes matrix synthesis, resulting in reorganisation of the spatial distribution of vascular smooth muscle cells and extracellular matrix, resulting in vascular thickening and increased arterial stiffness (6). Arterial stiffness is emerging as an interesting tissue biomarker for cardiovascular risk stratification (7). Stiffness affects the microvascular beds of the brain, kidneys, and heart by increasing the left ventricular systolic load necessary for coronary perfusion (5).
Arterial stiffness parameters such as the SI were measured. SI is calculated as the subject’s height (h) divided by the Pulse Transit Time (PTT), which is the time difference between the systolic and diastolic peaks in the pulse wave. SI measures large arterial stiffness (8). One common non invasive technique using simple and cost-effective optical technology is PPG. It is a waveform signal that indicates the pulsation of the chest wall and great arteries followed by the heartbeat.
The principle behind using this technique is to determine the propagation of blood pressure and vascular diameter changes during the cardiac cycle to the peripheral vascular system. The primary aim of PPG is to observe the mechanical movement of the heart and the kinetics of blood flow (9). Since increased arterial stiffness is the hallmark of many cardiovascular disorders, early detection can reduce associated morbidity and mortality. PPG, being a non invasive, portable, and cost-effective tool, facilitates better patient compliance and the screening of large groups of subjects. The aim of the study was to compare arterial wall stiffness among prehypertensives and normotensives using PPG. The primary objective was to measure and compare SI among prehypertensives and normotensives using the PPG module, and the secondary objective was to correlate anthropometric measures such as BMI and WHR with SI.
A pilot study was conducted at Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India from December 2022 to February 2023 after obtaining approval from the Institutional Ethics Committee (CSP-MED/21/JUL/70/116). A total of 20 male subjects were selected based on the following inclusion and exclusion criteria.
Inclusion criteria: Male subjects between 30-50 years of age were included in the study. Individuals with a SBP of 120-139 mmHg, and/or DBP of 80-89 mmHg were included in the prehypertensive group, while individuals with a SBP of 90-119 mmHg, and/or DBP of 60-79 mmHg were included in the normotensive group.
Exclusion criteria: Subjects suffering from cardiovascular diseases such as atrial fibrillation, frequent ventricular ectopic heartbeats, and conditions such as Raynaud’s phenomenon, significant limb tremor, deformation of limbs or measurement digit deformities, diabetes mellitus, hypercholesterolemia, and any other chronic diseases, as well as those who were on treatment or drugs, were excluded. Female subjects were also excluded from the study.
Sample size: The present study was a pilot for a larger study on the assessment of vascular aging through select parameters, and it included a total of 20 male subjects (N=10 normotensive and N=10 prehypertensive subjects).
Study protocol: After obtaining informed written consent from all the subjects, anthropometric data such as height (in metres) was measured using a stadiometer, weight (in kilograms) was measured using a weighing scale, and BMI was calculated using weight (in kg)/height (in m2) (as per WHO classification) (10). Blood pressure was measured after the subjects had rested for five minutes, and the average of three readings was considered. Waist Circumference (WC) and Hip Circumference (HC) were measured using an inch tape, and Waist-Hip Ratio (WHR) was calculated. Personal history regarding diet, smoking, alcohol use was obtained. Family history (chronic diseases like Hypertension, diabetes mellitus, hypercholesterolemia, etc.), Medical history, Drug history, Marital history, etc., were collected. Fasting Blood Sugar (FBS) levels, Serum Triglycerides (TGL), and Serum Low Density Lipoprotein (LDL) levels were also noted.
The pulse waveform reflects the systolic and diastolic events during the cardiac cycle. The stiffening of the arteries with ageing can affect the waveform and, therefore, the above haemodynamic events, which eventually lead to raised blood pressure even before obvious manifestations of frank hypertension (11). Hence, the measurement of SI may be more useful in the early identification of vascular changes, even in the absence of clinically apparent disease (11).
In the current study, the peripheral finger pulse was recorded using a PPG module and digitised using AUDACITY software. This PPG module records the Digital Volume Pulse (DVP), which has two peaks-SBP and DBP peaks. The former peak is caused by pulse waves that are directly transmitted from the left ventricle to the finger. The diastolic peak results from pulse waves that are carried via the aorta to the small arteries in the lower body, where they are subsequently reflected back along the aorta as a reflected wave. The length of this path corresponds to the subject’s height (h). The time interval between the diastolic and systolic peaks is known as the PTT (11).
SI is a tissue biomarker used to measure arterial stiffness (7). It was calculated using the formula SI (m/sec)=Subject height (m)/Peak to peak time (7). Reference value: SI=8.76±1.90 m/sec (7).
Statistical Analysis
After obtaining the data, statistical analysis was performed using SPSS version 24.0 The distribution of the data was analysed using the Kolmogorov-Smirnov test and expressed as mean±SD. The difference between the means of the two groups was analysed using an Independent t-test. Pearson’s correlation test was used to test the correlation between SI with anthropometric parameters and BP. A p-value of ≤0.05 was considered significant.
(Table/Fig 1) shows that the mean age of the samples was found to be 33.9±5.08 years. The mean height and weight of the samples were 176.4±7.39 cm and 83.9±15.0 kg, respectively. BMI and WHR showed a significant difference between normotensive and prehypertensive subjects, with p-values of 0.03 and 0.003, respectively. SI significantly increased in prehypertensives than normotensives (p=0.04) (Prehypertensives 11.2±2.51 and Normotensives 9.01±2.55).
Pearson’s correlation was applied to find the correlation between SI and other objective parameters such as BMI and WHR, SBP, and DBP. [Table/Fig-2-4] show a mild positive correlation of SI with SBP, DBP, BMI, and WHR, where their correlation coefficients (r) were found to be 0.35, 0.28, 0.2, and 0.15, respectively. However, there was no significant relationship among them.
In the present study, arterial stiffness was evaluated using SI, which is a measure of large artery stiffness. SI was found to be increased in prehypertensives compared to normotensives [12,13]. Prehypertensives with increased BMI and increased WHR (>0.90) showed an increase in SI in this study. In normotensives, subjects with higher BMI (≥25 kg/m2) showed a significant increase in SI. Higher BMI with increased SI would lead to vascular damage. In overweight and obese individuals, the increased serum leptin concentrations may predict arterial stiffness in patients with coronary artery disease (14). Increased serum leptin may augment the release of endothelin-I (vasoconstrictor), leading to vascular remodeling and thus stiffening of vessels, which would lead to vascular damage (15). Hyperleptinemia is an independent contributor to cardiometabolic syndrome in hypertensive patients (16).
WHR had a significant association with the development of large artery stiffness in prehypertensives. This might increase the after-load of the heart and thus increase BP (17). The pathophysiological mechanism in the above could be due to raised levels of angiotensin II in visceral obesity, which is known to induce collagen cross-link formation in the extracellular matrix, leading to vascular stiffness (18). Pearson’s correlation coefficient test between SI and parameters such as SBP, DBP, BMI, and WHR showed a mild positive correlation. Thus, if these parameters were likely to increase, there would be stiffening of arteries and the risk for CVDs would be high (19),(20).
A recent study conducted on children and adolescents revealed a noteworthy rise in arterial stiffness characteristics, serving as a stand-alone indicator for evaluating risk factors linked to CV illnesses (21). Latest research findings on the effects of prolonged exposure to ozone and emotional changes have shown both functional and anatomical alterations to the arterial wall in hypertensives and prehypertensives, respectively (22),(23). Thus, a potentially useful strategy for reducing morbidity and mortality associated with CVDs is the non invasive, economical technique of measuring arterial stiffness in conjunction with health promotion initiatives (24),(25),(26). Molecular studies, such as the role of free radicals to explain the actual cause and pathophysiological basis of prehypertension in young individuals, can be done in the future. Multicentric trials to evaluate the impact of emotional changes and environmental pollutants on arterial stiffness shall also be undertaken. Interventional studies, such as the role of relaxation exercises and meditation on lowering peripheral resistance and thereby arterial stiffness, can also be undertaken. Studies on the primordial prevention of CVDs by lifestyle modifications, such as consumption of Mediterranean diets rich in antioxidants and their effects on the SI, can also form part of cause and effect relationships.
Limitation(s)
The sample size of the current study was too small to establish the causal relationship of the variation in arterial SI in prehypertensives. In this study, authors were unable to establish the gender variation in SI, as the sample consisted of only male subjects.
This study concludes that SI, which is an important CV risk marker, shows a significant increase in prehypertensive subjects when compared to normotensive subjects. However, SI showed mild positive correlation with BP and other anthropometric measurements, though not statistically significant.
DOI: 10.7860/JCDR/2024/67377.19131
Date of Submission: Sep 05, 2023
Date of Peer Review: Nov 01, 2023
Date of Acceptance: Dec 29, 2023
Date of Publishing: Mar 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. NA
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ETYMOLOGY: Author Origin
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