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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
Correlation of Cross-sectional Area of the Umbilical Cord on Antenatal Ultrasound with Neonatal Birth Weight in Pregnant Women with and without Gestational Diabetes Mellitus: A Prospective Cohort Study
Correspondence Address :
Dr. Divyashree P Katti,
Senior Resident, Department of Radiology, Bangalore Medical College, Bengaluru-560002, Karnataka, India.
E-mail: divyaabdf4@gmail.com
Introduction: Many foetal and maternal complications, such as polyhydramnios, macrosomia, birth injuries, and operative interference, are linked with Gestational Diabetes Mellitus (GDM). Among these, macrosomia is particularly significant, as it increases the risk of shoulder dystocia, brachial plexus injury, birth asphyxia, and maternal complications, including emergency Lower Segment Caesarean Section (LSCS), Postpartum Haemorrhage (PPH), and perineal trauma. Therefore, one of the most essential perinatal goals in GDM is to predict macrosomia by estimating birth weight, thereby preventing adverse maternal and foetal outcomes.
Aim: To evaluate whether there is a correlation between the cross-sectional area of the Umbilical Cord (UCA) and the Neonatal Birth Weight (NBW) in pregnant women with GDM.
Materials and Methods: A prospective cohort study was conducted in the Departments of Radiology and Obstetrics Bangalore Medical College, Bengaluru, Karnataka, India. A total of 100 pregnant women (50 with GDM and 50 without GDM) were recruited from July 2021 to July 2022. Ultrasound examination (USG) was performed on pregnant women after 36 weeks of gestation. The UCA was measured in a free-floating loop, and the NBW was measured using a digital scale. The correlation coefficient was calculated to determine the degree of correlation between UCA and NBW.
Results: The mean age of the subjects was 26.5±3.9 years. The frequency of macrosomia was higher in the GDM group (8%) compared to the control group (4%). A strong positive correlation was observed between UCA and NBW in both diabetics (r=0.819) and control groups (r=0.736).
Conclusion: A strong positive correlation exists between UCA and NBW in women with GDM. Therefore, it should be estimated during routine antenatal USG for the prediction of birth weight in such women.
Birth injuries, Haemorrhage, Macrosomia, Polyhydramnios, Ultrasonography
One of the most common medical complications during pregnancy is Diabetes Mellitus (DM). Pregnant women can be categorised into those who had the onset of diabetes before pregnancy - pregestational DM; and those diagnosed during pregnancy - GDM (1),(2). The increasing incidence of type 2 DM has led to a growing number of pregnancies with GDM.
The prevalence of GDM in India varies from 3.8 to 21% (3),(4),(5), and the pooled global standardised prevalence is 14% (6). It is associated with many foetal and maternal complications such as macrosomia, premature rupture of membranes, preeclampsia, polyhydramnios, placental abruption, birth injuries, and operative interference. Among these, macrosomia is particularly important (7).
Macrosomia is defined as NBW ≥ 4000 grams or as gestational age-adjusted birth weight >90th percentile of the reference population (8). Approximately, 12% of newborns of women without GDM and 15-45% of newborns of women with GDM can be affected by macrosomia (8). Macrosomia results in an increased risk of shoulder dystocia, brachial plexus injury, meconium aspiration, thus causing neonatal morbidity and the need for assisted ventilation (9). Maternal complications result from operative delivery, which includes PPH, intra-abdominal infection, perineal lacerations (9). Therefore, one of the most essential perinatal goals in GDM is to predict macrosomia by estimating birth weight, thereby preventing adverse maternal and foetal outcomes. Foetal weight plays a significant role in obstetrical decision-making.
The purpose of the present study was to determine the correlation between UCA and NBW in the south Indian population and whether macrosomia can be predicted based on it, and also to assess whether the inclusion of UCA measurement in conventional biometry will improve prenatal detection of macrosomia.
A prospective cohort study was conducted in the departments of Radiology and Obstetrics, Bangalore Medical College, Bengaluru, Karnataka, India, from July 2021 to June 2022. After obtaining approval and clearance from the Institutional Ethics Committee (IEC number: BMCRI/PG/352/2019-20), a total of 100 pregnant women after 36 weeks of gestation were recruited.
Sample size calculation: Based on a previous study by Henan Dh et al., the umbilical cord area in pregnant women was 220.4±61.6 mm2, assuming equal standard deviation in the GDM group and expecting a minimum difference between the two groups to be 35 mm2 (10). The minimum sample size required was 50 in each group.
Inclusion and Exclusion criteria: Pregnant women with and without GDM and singleton pregnancies were included in the study. Pregnant women with pregestational diabetes, preeclampsia, multiple gestation pregnancies, foetal congenital anomalies, and maternal chronic diseases such as hypertension, cardiac diseases, renal diseases, pulmonary diseases, and epilepsy were excluded from the study.
Study Procedure
Detailed clinical history with clinical examination was conducted, and the findings were recorded in the case record form. The pregnant women were divided into two groups. Group-I included 50 pregnant women with GDM diagnosed based on the Diabetes in Pregnancy Study Group India (DIPSI) criteria, and Group-II included 50 pregnant women without GDM as controls. DIPSI is a one-step screening and diagnostic procedure with 75 gm of oral glucose advocated during the first Antenatal Care (ANC) visit, irrespective of the last meal, and a venous sample was drawn at two hours (11).
Ultrasound technique: USG was performed using the Samsung Accuvix A35 Ultrasound machine with a 2-5 Mega Hertz curvilinear transducer in all women after 36 weeks. All the ultrasound examinations were performed by a single radiologist with 11 years of experience in the field of obstetric radiology. UCA was measured in a free-floating loop, away from the foetal and maternal insertion site, according to the method used by Binbir B et al., (12). It was measured around the outer edges of the umbilical cord by using the trace function (Table/Fig 1),(Table/Fig 2). Three measurements were taken, and the average value was recorded.
Head Circumference (HC), Bi-parietal Diameter (BPD), Abdominal Circumference (AC), and Femur Length (FL) were measured, and Estimated Foetal Weight (EFW) was calculated using Hadlock’s formula.
Maternal and neonatal outcomes were observed by following-up with the women until delivery. The NBW was measured by a digital scale. Macrosomia was defined as a birth weight ≥4000 grams.
Statistical Analysis
The correlation coefficient was calculated to determine the degree of correlation between UCA and NBW using the Pearson’s correlation test (Table/Fig 3). The correlation coefficient was compared between the GDM and non GDM groups. Data were entered into a Microsoft excel data sheet and analysed using Statistical Package for Social Sciences (SPSS) 22.0 software. Categorical data were represented in the form of frequencies and proportions. Continuous data were represented as mean and Standard Deviation (SD).
Total 78% of the patients belonged to the age group of 21-30 years. The mean age of participants was 26.5±3.9 years, ranging from 19 to 36 years (Table/Fig 4). The mean gestational age at delivery was 39.3±0.96 weeks (Table/Fig 5). The average calculated Body Mass Index (BMI) was 25.1±2.16 kg/m2, 55% of the women were in the normal range (<25 kg/m2), 41% were overweight, and 4% were obese.
A total of 48 newborns were delivered by LSCS, and 52 were delivered by normal vaginal delivery. The average birth weight of the newborns was 3200±480 grams and ranged from 2000 to 5000 grams. The majority (88%) of the newborns were in the range between 2500 and 4000 grams (Table/Fig 6). A higher incidence of macrosomia was found in GDM Group (8%) compared to control Group (4%).
According to Hadlock’s formula, the average EFW was 3160 (±440) grams. The mean UCA was 228.5 (±54.99) mm2 and ranged from 130 to 330 mm2 (Table/Fig 7).
The authors found a strong positive correlation between UCA and NBW (r=0.79) [Table/Fig-8,9]. A strong positive correlation was also seen in both diabetic groups (r=0.819) and control groups (r=0.736). However, the correlation was stronger in GDM. A strong positive correlation was also found between NBW and EFW (r=0.860) (Table/Fig 10).
There was a stronger positive correlation (r=0.860) between EFW and NBW compared to UCA and NBW (r=0.79).
In the present study, a higher incidence of macrosomia was found in the GDM group. Among diabetics, 8% had NBW >4000 gm. However, in subjects without diabetes, only 4% had NBW >4000 gm. This correlates with the study conducted by Binbir B et al., in which 6 of 41 (14.6%) pregnant women with GDM or pre-GDM delivered macrosomic foetuses, while 5 of 50 (10%) fetuses delivered by non diabetic pregnant women were macrosomic (12). The relative risk of macrosomia for the diabetic group was found to be 1.5 times higher.
Naylor CD et al., reported the incidence of macrosomia as 16-29% in pregnant women with GDM and 10% in women without GDM (13). This finding is in accordance with the present study.
Henan Dh et al., studied the correlation between UCA and NBW and concluded that the NBW prediction by UCA is more accurate than that by Hadlock’s formula (10). A statistically significant correlation was found between the Wharton’s jelly and NBW (p-value <0.001).
Cromi A et al., found a large UCA in 11.1% (114/1026) fetuses, and the number of fetuses with a large UCA was significantly higher in the group of macrosomic fetuses than in that of non macrosomic fetuses, i.e., 29/53 (54.7%) vs. 85/973 (8.7%) (p<0.0001) (14). Rakesh KG and Amit M studied the UCA with pregnancy outcome and found a significant correlation between the NBW and UCA (p-value <0.001) (15). Barbeiri C et al., concluded that UCA is a weak prognosticator of the body weight (16). This difference might be due to a difference in gestational age (20-40 weeks) and inclusion of low-risk pregnancy in the study.
In a retrospective study by Predanic M and Perni S done in 470 women, in which umbilical cord diameter was measured at a gestational age of 18-23 weeks, no significant correlation was found between umbilical cord diameter and NBW (p=0.332) (17).
Jain N and Singh A found that in women without GDM, UCA was comparable at 30-32 weeks (224.0 mm2) and 36-38 weeks (228.8 mm2) without a significant increase in UCA with advancing gestational age (18). However, in the group with GDM, a significant increase was seen from 30-32 weeks (239.7 mm2) to 36-38 weeks (250.1 mm2), showing that in women with GDM, UCA increases significantly with advancing gestational age.
The most widely used formula for the assessment of foetal weight is the one proposed by Hadlock based on foetal biometric measurements. The positive predictive value of EFW is between 60 and 79% (19). Cromi A et al., concluded that there is a significant improvement in the positive predictive value for macrosomic fetuses when EFW and UCA are combined (14). The assessment of UCA is not likely to be affected by amniotic fluid volume or gestational age.
In the present study, there was a stronger positive correlation (r=0.860) between EFW and NBW compared to UCA and NBW (r=0.79). This differs from the study conducted by Henan Dh et al., who compared the EFW obtained by UCA with that of Hadlock’s formula (10). Upon comparing these two methods, they found that the prediction of NBW by UCA is more accurate than that by Hadlock’s formula (R2 0.38 vs. 0.194).
In late pregnancy, UCA is an easily obtained sonographic value, unlike sonographic measurement of conventional biometric parameters (FL, BPD, HC, AC), which are technically difficult due to the relatively low position of the foetal head, distortion of AC, and posterior position of the femora. An additional advantage is that it took significantly less time for satisfactory measurement.
Limitation(s)
The basis for the larger umbilical cord in women with GDM is an increased amount of Wharton’s jelly. The authors did not calculate the cross-sectional area of Wharton’s jelly and umbilical cord vessels separately. The authors included women after 36 gestational weeks; thus, further studies are required to find the correlation between UCA and NBW in earlier gestational ages. Since all the examinations were performed by a single radiologist, the interobserver variations could not be accounted for.
A strong positive correlation was seen between UCA and NBW. Therefore, a large UCA can be used to predict foetal macrosomia in a simple and reliable manner. UCA measurement can also be combined with the other foetal biometric parameters to increase the accuracy of foetal macrosomia prediction.
DOI: 10.7860/JCDR/2024/66258.19080
Date of Submission: Jul 05, 2023
Date of Peer Review: Sep 05, 2023
Date of Acceptance: Dec 14, 2023
Date of Publishing: Feb 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. Yes
PLAGIARISM CHECKING METHODS:
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ETYMOLOGY: Author Origin
EMENDATIONS: 7
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