Review Article | DOI: https://doi.org/10.31579/2693-2156/165
President of all nations,Morning star hospital, Marthandam, Kanyakumari District, Tamil nadu state, India.
*Corresponding Author: Ramachandran Muthiah, President of all nations,Morning star hospital, Marthandam, Kanyakumari District, Tamil nadu state, India.
Citation: Ramachandran Muthiah, (2026), Acute Rheumatic Fever with Malarial Infection- An Immune Mediated Pathogenesis, J Thoracic Disease and Cardiothoracic Surgery, 7(2); DOI:10.31579/2693-2156/165
Copyright: © 2026, Ramachandran Muthiah. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 09 April 2026 | Accepted: 20 April 2026 | Published: 11 May 2026
Keywords: febrile episodes; acute rheumatic fever; aso titer; malarial infection; carditis, immune response; duffy blood group antigen
The coexistence of acute rheumatic fever (ARF) with malarial infection is uncommon, its pathogenesis remains unexplained and may related to altered immune status, a unique dual challenge in immunology. Both malaria and ARF can present with high fevers, joint pain (arthralgia), making the clinical diagnosis in endemic areas very difficult. Fever pattern is helpful to diagnose the associated infection with ARF and malaria produces a relapsing fever at 48 hrs interval in plasmodium vivax infection. In ARF, virulence factors, infectious burden and genetic susceptibility play a role. The concept of ‘rheumatogenic’ strains is inadequate and the infectious burden of Strep A (streptococcus A) that “primes” the immune system for dysregulation and self-reactivity during the window period between the onset of Strep A infections and the development of ARF, potentially exacerbating the systemic inflammation and autoimmune responses. The circulating antistreptococcal cross-reactive antibodies and malaria-induced immune complexes aggravate the inflammation of carditis and valvulitis in ARF.
Acute Rheumatic Fever remains a challenge to physicians in developing countries since cyclic fevers with chills synchronous with periodicity may develop in partially immune patients who were previously infected with malarial parasites [1] due to the rupture of infected red blood cells [2]. In those people who were not infected with malarial parasites earlier, the febrile paroxysms are asynchronous and no periodicity since they are not immune to the infection. Altered immune status occurred due to previous infection with P. vivax since it is partially immune as evidenced by 48 hrs periodicity of fever pattern. Similarly repeated pharyngeal infection with group A β hemolytic streptococci as evidenced by raised ASO (anti streptolysin O) titers is necessary to prime the immune response [3] before the first episode of acute rheumatic fever to occur. In tropical countries, there is high prevalence of mixed infections and so, the possibilities of other infections must be evaluated if fever is not responding to routine therapy in acute rheumatic fever.
Etiopathogenesis
Figure 1: shows Thickened mitral valve tips suggesting Rheumatic involvement in a 12-year-old boy
Figure 2: shows mild mitral regurgitation and moderate aortic regurgitation suggesting Rheumatic carditis in a 12-year-old boy
Figure 3: shows Trophozoites of P. vivax in a 12-year-old boy
Malarial fever
Malaria is transmitted through the bite of a female Anopheles mosquito, sporozoites are released from the mosquito salivary glands into host’s skin (dermis), enter the bloodstream, circulate to the liver and invade hepatocytes and differentiate. During this pre-erythrocytic stage as shown in Figure 4, the infection is not apparent clinically, antibodies (Abs) developed against the circumsporozoite surface protein which trap the sporozoites in the skin and reduce their motility to liver cells. Similarly, the Ab-dependent cellular cytotoxicity, interferon-g -producing CD4+ and CD8+ T cells, NK cells and gd T cells destroy the infected liver cells, but the naturally occurring acquired immunity at this stage is not much effective to prevent the recurrent infections in endemic areas. The circumsporozoite protein forms the basis of malaria vaccine and both Abs and CD4+ T cells contribute to 50?ficacy [4].
The infected liver cell will rupture, releasing the merozoites which invade the red blood cells (RBCs) and maturing from rings to trophozoites to form the schizonts. Eventually, the schizonts rupture to release more merozoites into the bloodstream and clinical symptoms of malaria (fever, headache, nausea) occurs during this erythrocytic or blood stage of infection, at this stage, the pro-inflammatory cytokines (IL-1b, IL-6, IFNg, TNFa and IL-12), which enhances phagocytosis and killing of iRBCs (infected red blood cells) by macrophages. However, over-production of these cytokines contributes to malarial pathology and true relapses originate from the dormant liver stages called hypnozoites, which are produced by P. vivax and P. ovale [5].
Figure 4: showing the malaria life cycle
According to the ecological assumptions about the thermal physiology of insects, it is found that malaria transmission does not occur at temperature below 16◦C or above 33◦C and at altitude > 2000 m above sea level [4] since the development in the mosquito (sporogony) cannot occur. Definitive diagnosis of malaria generally requires direct observation of malaria parasites in Giemsa-stained thick and thin blood smears. Thick blood smears are more difficult to interpret and the thin smears, in which the parasites are seen within the erythrocytes as in Figure 3, used to determine the species of the infecting parasite [6].
Acute Rheumatic Fever (ARF)
Acute rheumatic fever (ARF) is an immune disorder due to repeated infections (infectious burden) with group A Streptococcus (GAS) [7] and recurrent episodes can lead to rheumatic heart disease (RHD) [8] as shown in Figure 5. The virulence factors as in Figure 6 that are surface-bound (Hyaluronic acid capsules, S protein, Deoxyribonucleases (DNases), streptokinase, immunoglobulin degrading enzyme) well as secreted (streptococcal pyrogenic exotoxin B (Spe B), streptococcal lysozyme streptolysins S and O (SLS and SLO), NAD glycohydrolase (NADase), Hyaluronidase, C5a peptidase [9] induces the colonization, evasion of host immune response and the progress of inflammation and autoimmune reactions.
Figure 5: showing the infectious burden of streptococcus A leading to Rheumatic fever
Figure 6: showing the Cell surface structure of Streptococcus pyogenes and secreted products involved in virulence.
Glycoprotein biology (Molecular mimicry)
Molecular mimicry refers to the sharing of antibodies or T-cell epitopes between the host and a microbe. The immune response against streptococcal antigens can lead cross-recognition of heart tissue proteins resulting in rheumatic heart disease (RHD). The rheumatogenic streptococci contain multiple antigenic determinants that partially mimic normal human tissue antigens. These antigens are recognized as foreign by the susceptible host and induces a hyperactive cellular and humoral immune responses. One type involves the recognition of similar structures by antibodies. The alpha-helical structures of protein are found in the N-acetyl-beta-D-glucosamine (S. pyogenes carbohydrate antigen) cross react with antibodies to the heart valve tissue [10]. Another type of molecular mimicry may contribute to immunological cross-reactivity as shown in Figure 7 between diverse molecules, such as DNA and proteins or carbohydrates and peptides [11]. Antibodies induced by group A carbohydrate epitope GlcNAc react with human cardiac proteins, including myosin and laminin, and are capable of causing humoral immune damage. Myosin is an intracellular antigen that is not expressed in human heart valves. M protein shares the epitopes of cross-reaction antibodies with myosin. The streptococcal M protein homology with contractile (myosin, tropomyosin) and interstitial [keratin, laminin, vimentin) proteins and the interstitial reaction of anti-M protein antibody induces the myocarditis whereas the cellular immunity to the shared antigenic determinants contributes the pathogenesis of valvulitis.
Superantigens
Two streptococcal antigens the pepsin generated fraction of M protein and a streptococcal pyrogenic exotoxin (Spe’s) are believed to behave as “Superantigens”. The M protein epitopes not only can trigger the heart cross reactive antibodies, but can also act as superantigens to result in a more widespread immune response by overriding the histocompatibility barrier [12]. These antigens do not bind to antigen binding clefts in T or B cells and can amplify an immune response by clonal expansion of T and B cells, release several cytokines (TNFα, IL I β, IL-6), inducible nitric oxide synthase and adhesion molecules, which could help to localize immune responses to certain tissues. Super antigenic stimulation may help T cells respond to antigens like M proteins suggest a potential mechanism mediating the unrestrained immunologic assault postulated to cause acute rheumatic fever [13].
Figure 7: showing the immunological cross reactivity
Rheumatic carditis
The genesis of carditis based on humoral theory due to myocardial damage is uncertain since myocyte necrosis is not a prominent feature [14] and pathological damage is seen in heart valves while no residual damage is observed in myocardium or pericardium after the resolution of ARF.
M protein is the major virulence determinant for S. pyogenese, an alpha-helical coiled coil molecule with extensive variation in structure between Strep A strains, which appears like the fuzz on a tennis ball when viewed by transmission electron microscopy as shown in Figure 8.
Figure 8: showing the thin section electron micrograph of a chain of streptococci showing the surface M protein. Magnification 50,000x [15]
The N-terminal includes the region coded by the emm gene used for typing Strep A strain types. The C-terminal is anchored in the cell wall, with various repeats (A, B, C, and D) intervening and increasing in sequence conservation between strains. Variation in this structure is known as emm pattern and are designated as patterns A-C (pharyngeal tropism), D (skin tropism), and E (pharyngeal and skin tropism) as shown in Figures 9 and 10.
Collagen has been suggested as the primary target of inflammation in ARF [16], with M-protein binding to type IV collagen in the basement membrane, possibly by the peptide associated with rheumatic fever (PARF) motif of M protein, resulting in autoantibodies to collagen epitopes exposed by M-protein binding (cryptic epitopes as shown in Figure 11) that don’t cross react to M-protein to initiate autoreactivity
[17]. It has been also pointed out that antibodies cross-reactive with myosin were originally identified binding to the valvular endothelium, presumably due to similarity in structure between laminin, myosin, and M-protein [18]. Vascular cell adhesion molecule 1(VCAM 1) may be the connection between humoral and cellular immunity at the surface of the valve. M1 macrophages and the very late antigen 4 (VLA4)/vascular cell adhesion molecule-1 (VCAM-1) pathway may be involved in the inflammatory infiltration and valvular fibrosis in RHD. VCAM 1 gets upregulated at the surface of the endothelium because of the cross-reactive antibodies binding which results in the adherence of CD4+ T cells to the endothelium thereby subsequently infiltrating those cells to the valve [19].
Figure 9: showing the M-protein structure and pattern variety.
Figure 10: showing the Characteristics of the complete M6 protein sequence
Recent study from Uganda, identified a group of febrile children with echo identified valvular involvement as the sole manifestation, termed as “silent ARF.” [20]. The morphological changes associated with RHD often develop at a later stage of disease and thus are not required for the diagnosis of acute carditis in the setting of ARF. “Latent RHD” can occur without a preceding pharyngitis or ARF and it is more common in India [21]. Some patients with acute rheumatic fever have echocardiographic evidence of thickened mitral leaflet tips as in Figure 1 with mitral and aortic regurgitations as in Figure 2 suggesting the rheumatic carditis as stage B category [22].
Figure 11: showing the cryptic collagen epitopes [23]
Disruption of immune tolerance
There is no molecular mimicry between the Scl (streptococcal collagen-like) proteins of streptococcus and human collagen [24] and a sustained disparity between Th17 cells and regulatory T cells (Tregs) may disrupt immune tolerance to enhance the susceptibility of the host to streptococcal infection [25]. GAS infection induces the production of TGF-β1, that facilitates the differentiation of Tregs and Th17 cells. Nasopharyngeal-associated lymphoid tissue (NALT) stimulate the antigen uptake, the microfold (M) cells in the NALT overlying epithelium actively sample airborne antigens to activate the mucosal immune response [26]. Prothymosin Alpha induces the pathological immune response of CD8+ T-cells regulated by estradiol receptor alpha (ERα), and also to recognise the type I collagen, in rheumatic heart disease [27].
Epigenetic priming
During the early stage, streptococcus infection activates immunoglobulin G2 autoantibodies (Ig G2), directed against the GlcNAc epitope in the heart valve tissues and these antibodies serve as biomarkers to predict the risk of autoimmune responses following GAS infections [28]. With recurrent infections, the accumulation of IgG2 antibodies may activate the inflammatory response in the valve endothelium and stimulate the inflammatory T-cell subsets such as Th1 and Th17 to cause pro-fibrotic gene expression in endothelial and interstitial cells of cardiac valves [29]. The progression of ARF to RHD, involving epigenetic modification following Strep A mucosal infection and this epigenetic priming along with haemodynamic stress due to transvalvular pressure gradients, initiate valvulitis during ARF through TGF-β1 signalling [30], resulting in progression to chronic RHD characterised by ongoing valvular fibrosis and calcification. Thus, a breakdown of immune tolerance in the host, followed by systemic immune dysregulation, ultimately favouring a pro-inflammatory response to RHD [31].
Immunological periscope
Mucosa-associated invariant T (MAIT) cells recognize MR1 antigens produced during microbial riboflavin biosynthesis and eliciting protective innate immune responses against microorganisms that generate such metabolites. In GAS infection, high activation of human MAIT cells to contribute the initial cytokine response [32] in the pathogenesis of ARF [33]. MR1(Major Histocompatibility Complex class I-related 1) is an immune protein that acts as an "immunological periscope" to detect intracellular infections and it works by presenting small organic molecules (specifically vitamin B metabolites) to MAIT (Mucosal-Associated Invariant T) cells, acting as a rapid sensor for microbes.
Cytokine and chemokine dysregulation
IL-1β-GM-CSF axis NLRP3 Inflammasome (NOD-, LRR- and pyrin domain-containing protein 3) is an intracellular sensor that detects a broad range of microbial motifs) via the induction of pro-inflammatory cytokines, such as IL-1β and IL-18, which in turn stimulate CD4+ T lymphocytes [34], which play a role in the pathogenesis of myocarditis by stimulating Th cells [35] and it is the main source of GM-CSF. The increased production of nterleukin-1β in peripheral blood mononuclear cells in ARF can lead to dysregulated cytokine signaling, specifically the IL-1β-GM-CSF axis (interleukin-1β-granulocyte-macrophage colony-stimulating factor IL-1β-GM-CSF) [36], leading to the specialized migration of TH1 cells to the mitral valve and immunomodulatory drugs [37] are aimed at treating patients at high risk for ARF.
Chemokines
The chemokines, CXCL9/Mig (also known as MIG, or Monokine Induced by Gamma Interferon) is an inflammatory cytokine that belongs to the CXC chemokine family, acts as a chemical signal to recruit immune cells, particularly activated T cells and Natural Killer (NK) cells to sites of inflammation and can enhance T-cell recruitment in valvular tissue lesions [38] and C-C chemokine receptor type 2-positive (CCR2+) macrophages, a specific subset of immune cells primarily derived from circulating blood monocytes. They are actively recruited to sites of inflammation and tissue injury by the chemokine ligand CCL2 (also known as MCP-1) in autoimmune diseases and tissue fibrosis, and suggest that they are critical for valve remodeling in RHD [39] as shown in Figure 12.
Figure 12: showing the Cytokine and chemokine mediated autoimmunity in blood and heart valve tissue during acute rheumatic fever and rheumatic heart disease.
Genetic correlations
HLA genotypes
HLA antigen may account for individual susceptibility to rheumatic fever and only a few develop RHD, and the incidence is three times higher in monozygotic than in dizygotic twins [40]. There is a significant association between specific HLA class II antigen, HLA DR2 in blacks, HLA DR4 in whites, HLA DR4 in the United States and Saudi Arabia, HLA DR3 and DQw2 in India, HLA-DR15 and DRB5 alleles with mitral valve disease (10%) and rheumatic fever [41]. In contrast, Ozkan et al study revealed HLA-DR5 is a protective factor against RHD [42] and B cell alloantigen D8/17 have shown a strong susceptibility to rheumatic fever [43]. The distribution of class I HLA antigens in rheumatic fever is inconclusive.
Duffy Antigen Receptor
HLA BW53 protects against malaria due to a polymorphism in TNFα promoter region and in Plasmodium vivax, that determines resistance is the genetic polymorphism of parasite receptor known as Duffy Antigen Receptor for Chemokines (DARC) [44], [45] as shown in Figure 13. An approach to identify small molecule inhibitors of DARC should prove to be of benefit in drastically reducing P. vivax malaria. Duffy-negative allele, lack of expression of chemokines receptor and Chemokines sink to amplify the immune response that does not allow the entry of the parasite to the red blood cells (RBCs) [46].
Figure 13: A) The human chemokine binding protein DARC is expressed on erythrocytes and is used by P. vivax to gain entry to the cell.
It can be inhibited by a monoclonal antibody to DARC, Fy6, and by chemokines such as CXCL1 and CXCL8 [47]
There are two kinds of alleles related to the receptors DARC: Fya and Fyb, which identifies four possible phenotypic presentations: homozygous Fy (ab−) (absence of the receiver or null), homozygous Fy (a+ b+) and heterozygous Fy (a− b+) and Fy (a+ b−). These receptors belong to the family of seven transmembrane molecules, initially recognized as a receptor for the Plasmodium vivax in human red blood cells. They are recognized as a “promiscuous” receptor which is able to bind both CC (β-chemokines, primarily attract monocytes, macrophages, and T lymphocytes to the sites of chronic inflammation) and CXC chemokines (α-chemokines, predominantly recruit neutrophils to sites of acute inflammation) and to have a cleaner role of these molecules [48].
Mannose-binding lectin (MBL)
In RHD patients, there is significantly increased levels of mannose-binding lectin (MBL- an innate mediator) occurs. MBL acts as a primary pathogen-recognition molecule that drives the lectin complement pathway and this cascade exacerbates inflammation and tissue damage, targets the body’s own heart valves, causing severe valvular damage. There is a beneficial role for MBL deficiency in these patients [49].
‘Vitamin C ‘hypothesis
The genus Homo lost the ability to synthesize Vitamin C corresponding with the evolution of color vision [50] and Streptococcus got adapted to infect species that have a limited ability to synthesize vitamin C, such as humans and guinea pigs [51]. Humans, in contrast to many animals, are incapable of synthesising this vitamin (Vitamin means that one has to eat it) and are totally dependent on its dietary intake. Szent-Györgyi, in October 1937, was awarded the Nobel Prize for Physiology or Medicine “for his discoveries in connection with the biological combustion processes, with special reference to vitamin C (antiscorbutic factor from lemon juice and named it as vitamin C and Szent-Györgyi had suspected that hexuronic acid was, in fact, vitamin C)”. The concept of mega doses of vitamin C have a beneficial effect and Linus Pauling, winner of two Nobel prizes (Chemistry Prize in 1954, Peace Prize in 1962) suggested that the intake of vitamin C should be about 2.3 g per day for the maintenance of general health, and increased intake up to 10 g/day for combating infectious diseases, including the common cold as well as prevention and cure of cardiovascular diseases and cancer. In humans, a regular intake of about 2 g vitamin C/day should protect a moderate smoker (10–15 cigarettes/day) from emphysema [52].
Immune signature (Immune Priming)
There is marked heterogeneity in the ARF autoantibody profile [53]. Both serological and epidemiological data suggest that repeated GAS infections prime the immune system and break the immune tolerance to develop ARF [54],[55]. There is increasing evidence that GAS skin infections might also be a trigger for ARF, either directly or as part of immune priming [56]. The repeated exposures of GAS drive the exaggerated IgG3 responses to M-proteins observed in ARF leads to immune dysregulation [57] as in Figure 14.
Figure 14: showing the elevated IgG3 in ARF ((A) illustrating the distribution of IgG3 concentrations across study groups. (B) A receiver operator curve (ROC) curve comparing ARF to all controls [58].
The observation of elevated IL-6, complement C4 and CRP (C4-CRP-IL6 inflammatory triad), points clearly to the inflammation underlying ARF [59] and the immune signature is shown in FIgure 15.
Figure 15: showing the immune signature comprising inflammatory markers, IgG3, and Streptococcus pyogenes-specific antibodies in acute rheumatic fever.
Epidemiological surveys
In tropical countries, mixed infections of streptococci both in the throat and skin due to various strains are more common. Group C or G streptococcus are frequently isolated from the throat than Group A streptococcus in Rheumatic Fever patients in high-risk indigenous populations of Aboriginal communities in Australia [60], [61] and Māori and Pacific Peoples in Aotearoa New Zealand [62] and they can occur virulence factors by horizontal transmission from Group A streptococci. There is a high prevalence of rheumatic fever in patients with skin lesions even though streptococcal pyoderma does not cause Rheumatic fever [63] since streptolysin O is irreversibly inactivated by lipids (probably cholesterol) present in the skin and unable to induce increased magnitude of the immune response to produce rheumatic fever [64]. Earlier studies categorically differentiated the nephritogenic and rheumatogenic strains, but recent studies displace this concept by suggesting that both mucosal and skin infection with GAS can lead to long-term cardiac sequelae [65]. Epidemiological surveys are necessary to find out whether any higher incidence of acute rheumatic fever in endemic areas of malaria and any association with specific blood group antigen especially with duffy factor. More recent progress to diagnose GAS pharyngitis include Nucleic Acid Amplification Tests (NAATs), which have much better sensitivity and specificity than RADTs (rapid antigen detection test) [66]. The difference between GAS pharyngitis and viral pharyngitis is shown in Table 1
| S.No | Streptococcal pharyngitis | Viral pharyngitis |
1.
2.
3
4
5. | headache, abdominal pain, nausea, vomiting and no diarrhea.
Fever of more than 38◦C and lack of cough.
Tendor or swollen anterior cervical nodes
tonsillar exudates (white patches/pus on the tonsils) or swelling
Pain with swallowing | Prominent catarrhal, symptoms common cold-like symptoms (watery eyes, running nose) Fever with dry cough may occur
Cervical nodes not enlarged
Tonsils and throat are red with vesicles and ulcers
Uncomfortable throat |
Table 1: showing the difference between streptococcal pharyngitis and viral pharyngitis
Therapeutics
ARF Treatment requires immediate antibiotic therapy to eradicate the streptococcus bacteria, anti-inflammatory medications (like aspirin) to control joint and heart inflammation, and long-term secondary antibiotic prophylaxis {SAP) to prevent recurrences. ASA (Aspirin (Acetylsalicylic Acid) (60 to 100 mg/kg/day in divided doses until symptom resolution) is the most commonly used NSAID in the treatment of ARF with a dramatic response and resolution of fever and arthritis in 1 to 3 days. However, there is no documented evidence showing superior efficacy of any drug (steroids or NSAIDs) in reducing the risk of rheumatic valve damage (RVD) in patients with ARF [67]. The recent meta-analysis of 51 studies on secondary prophylaxis showed that good adherence to reduce the progression of the disease by 71% [68].
GAS is exclusively a human pathogen, co-evolved with Homo Sapiens and exists in a carrier state in the throat and skin in about 20% of children [69]. The antibiotic, cephalosporins have some superiority in eradicating GAS infections since they reduce the penicillinase-generating pharyngeal flora, which are implicated in GAS carrier state [70]. Recently it is found that Immunoglobulins are of no value in the management of acute rheumatic fever [71].
In 1965, American chemist Robert Burns Woodward was awarded the Nobel Prize in Chemistry for the first total synthesis of quinine, one of the earliest and most effective antimalarial drugs. Malaria treatment via standard antimalarial medications (e.g., Artemisinin-based Combination Therapy or chloroquine), depending on the specific parasite strain (P. falciparum or P. vivax) and local resistance patterns is widely practiced. Mefloquine is not recommended for patients with cardiac conduction defects or who are taking β blockers. Arrhythmogenic effects of chloroquine are not seen at normal doses, but do occur with rapid intravenous infusion or massive overdoses. In areas co-endemic for P vivax and Plasmodium falciparum, there is an increased risk of P. vivax parasitaemia with sexual stages [72] and it is a rationale for opportunistically eradicating P. vivax hypnozoites from the liver, an approach termed universal radical cure. Most endemic countries currently recommend a low-dose regimen of primaquine (total dose 3·5 mg/kg) for the radical cure of P vivax malaria, administered over 14 days [73],[74]. This prolonged treatment limits the daily dose of primaquine to 0·25 mg/kg per day to improve tolerability and to reduce the risk of drug-induced haemolysis [75].
Immunomodulatory therapy
There is a complete lack of therapies that can halt the progression of ARF to RHD [76]. The immune profile suggests that IL-6 or TNFα blockade could be effective for suppression of this acute disease state.
Il-6 blockade
IL-6 blockade by the humanized anti-IL-6R IgG1 monoclonal antibody, the Tocilizumab (TCZ) has proven effective in multiple autoimmune diseases. Elevated circulating levels of IL-6 in ARF and RHD suggests that TCZ is a promising immunomodulating therapy. According to genetic studies, including a New Zealand study, it is found that IL-6 related variants increase the susceptibility to RHD [77]. The inflammatory parameters, CRP decrease and reduced immune cell infiltration by TCZ are beneficial in ARF and it also modulates M2 macrophages known to have a pathological role in fibrosis of valves in RHD [78]. TCZ has been proposed as a promising broad action immunomodulating drug for a large variety of “chronic intractable immune mediated diseases,”. Tocilizumab has also shown to reduce serum IgG3 levels clinically and the available evidence suggests that ARF and RHD should be included under this therapy [79], [80].
TNFα Blockade
TNFα is variably increased in Acute phase of RF (Rheumatic fever) [81], shown to regulate pro-inflammatory cytokines including IL-1, IL-6, GM-CSF, and IL-8/CXCL8 and TNFα blockade in clinical trials to dampen this pro-inflammatory “cascade” with its ability to reduce the cell mediated tissue ingress and systemic autoimmunity, it is worth exploring as a therapeutic option for ARF and RHD.
TGFβ inhibition
TGFβ is a pleiotropic cytokine growth factor, and is known to cause cardiac damage. Increased TGFβ has been observed in RHD heart valves, with significant correlations to immune cell infiltration, neovascularization, calcification, myofibroblast proliferation, and valvular fibrosis [82]. Inhibition of TGFβ signaling will make an understanding of the pathogenesis RHD, and to evaluate its value as a target for intervention.
IP-10/CXCL10 inhibition
The increased levels of IP-10/CXCL10 seen in ARF and its association with adverse outcomes in post-surgery in RHD, warrants further investigation to ameliorate the disease.
Rituximab
It is a chimeric anti-CD20 monoclonal antibody therapy that acts via transient B cell depletion. Since antibody deposition on heart valves is important to the pathogenesis of ARF/RHD, B cell depletion may be a possible therapeutic approach to control the disease [83].
Hydroxychloroquine
Hydroxychloroquine (HCQ) suppresses an interleukin-1β-granulocyte-macrophage colony-stimulating factor cytokine axis, reported to be dysregulated in peripheral blood mononuclear cells of acute rheumatic fever. HCQ treatment was associated with control of inflammatory markers, pericarditis and stabilization of progressive carditis [84].
Strep A vaccine
The hypothesis of immune priming suggests that multiple infectious events are required to cause ARF and a precise extent of strain coverage is needed to prevent ARF by vaccination, but whether long term immune memory generated to Strep A is uncertain [85],[86].
Acute rheumatic fever (ARF) is an autoimmune response to untreated Group A streptococcal throat infections, whereas malaria is a parasitic infection. These two distinct conditions are often medically intertwined due to overlapping symptoms such as high fevers and joint pain which can make it difficult to differentiate them in tropical regions of India. Studies have shown diagnostic overlaps where patients (especially children) test positive for malaria but also meet the criteria for ARF. Failing to treat ARF can lead to permanent Rheumatic Heart Disease. Clinicians rely on rapid diagnostic tests for malaria, throat cultures, antistreptolysin O (ASO) titers and echocardiography to distinguish and treat both diseases appropriately. India bears a significant burden of both diseases and treating ARF aggressively alongside malaria is crucial for preventing RHD. Local healthcare infrastructure continues to focus on improving both public awareness and early echocardiographic screening.
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Dear Grace Pierce, Editorial Coordinator of the journal IJCCR, I had a very positive experience with Auctores - Journal throughout the publication process. The Editorial Team was highly responsive, professional, and supportive at every stage. I would like to extend my sincere thanks to the Editor: Grace Pierce, for her guidance and assistance. The peer-review process was smooth and constructive, helping improve the quality of my work. I would gladly recommend Auctores Journal to fellow researchers and authors. Dr. SABITA SINHA, Medical Oncologist, MD (Electro Homeopathy).
Dear Mayra Duenas, Editorial Coordinator of the journal IJCCR, I write here a little on my experience as an author submitting to the International Journal of Clinical Case Reports and Reviews (IJCCR). This was my first submission to IJCCR and my manuscript was inherently an outsider’s effort. It attempted to broadly identify and then make some sense of life’s under-appreciated mysteries. I initially had responded to a request for possible submissions. I then contacted IJCCR with a tentative topic for a manuscript. They quickly got back with an approval for the submission, but with a particular requirement that it be medically relevant. I then put together a manuscript and submitted it. After the usual back-and-forth over forms and formality, the manuscript was sent off for reviews. Within 2 weeks I got back 4 reviews which were both helpful and also surprising. Surprising in that the topic was somewhat foreign to medical literature. My subsequent updates in response to the reviewer comments went smoothly and in short order I had a series of proofs to evaluate. All in all, the whole publication process seemed outstanding. It was both helpful in terms of the paper’s content and also in terms of its efficient and friendly communications. Thank you all very much. Sincerely, Ted Christopher, Rochester, NY.
International Journal of Clinical Case Reports and Reviews is a high quality journal that has a clear and concise submission process. The peer review process was comprehensive and constructive. Support from the editorial office was excellent, since the administrative staff were responsive. The journal provides a fast and timely publication timeline.
Dear Cecilia Lilly, Editorial Coordinator, Endocrinology and Disorders, Thank you so much for your quick response regarding reviewing and all process till publishing our manuscript entitled: Prevalence of Pre-Diabetes and its Associated Risk Factors Among Nile College Students, Sudan. Best regards, Dr Mamoun Magzoub.
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. I am really grateful for the peers review; their feedback gave me the opportunity to reflect on the message and impact of my work and to ameliorate the article. The editors did a great job in addition by encouraging me to continue with the process of publishing.
Dear Mayra Duenas, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews Herewith I confirm an optimal peer review process and a great support of the editorial office of the present journal
Dear Maria Emerson, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews’, I appreciate the opportunity to publish my article with your journal. The editorial office provided clear communication during the submission and review process, and I found the overall experience professional and constructive. Best regards, Elena Salvatore.
Dear Editorial Team, Journal-Clinical Cardiology and Cardiovascular Interventions, “Publishing my article with Clinical Cardiology and Cardiovascular Interventions has been a highly positive experience. The peer-review process was rigorous yet supportive, offering valuable feedback that strengthened my work. The editorial team demonstrated exceptional professionalism, prompt communication, and a genuine commitment to maintaining the highest scientific standards. I am very pleased with the publication quality and proud to be associated with such a reputable journal.” Warm regards, Dr. Mahmoud Kamal Moustafa Ahmed
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. It was truly a rewarding experience to work with the journal “Clinical Cardiology and Cardiovascular Interventions”. The peer review process was insightful and encouraging, helping us refine our work to a higher standard. The editorial office offered exceptional support with prompt and thoughtful communication. I highly value the journal’s role in promoting scientific advancement and am honored to be part of it. Best regards, Meng-Jou Lee, MD, Department of Anesthesiology, National Taiwan University Hospital.
Dear Maria Emerson, Editorial Coordinator, Journal of Clinical Research and Reports. Thank you for publishing our case report: "Clinical Case of Effective Fetal Stem Cells Treatment in a Patient with Autism Spectrum Disorder" within the "Journal of Clinical Research and Reports" being submitted by the team of EmCell doctors from Kyiv, Ukraine. We much appreciate a professional and transparent peer-review process from Auctores. All research Doctors are so grateful to your Editorial Office and Auctores Publishing support! I amiably wish our article publication maintained a top quality of your International Scientific Journal. My best wishes for a prosperity of the Journal of Clinical Research and Reports. Hope our scientific relationship and cooperation will remain long lasting. Thank you very much indeed. Kind regards, Dr. Andriy Sinelnyk Cell Therapy Center EmCell
I recommend without hesitation submitting relevant papers on medical decision making to the International Journal of Clinical Case Reports and Reviews. I am very grateful to the editorial staff. Maria Emerson was a pleasure to communicate with. The time from submission to publication was an extremely short 3 weeks. The editorial staff submitted the paper to three reviewers. Two of the reviewers commented positively on the value of publishing the paper. The editorial staff quickly recognized the third reviewer’s comments as an unjust attempt to reject the paper. I revised the paper as recommended by the first two reviewers.
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation. “The peer review process was efficient and constructive, and the editorial office provided excellent communication and support throughout. The journal ensures scientific rigor and high editorial standards, while also offering a smooth and timely publication process. We sincerely appreciate the work of the editorial team in facilitating the dissemination of innovative approaches such as the Bonori Method.” Best regards, Dr. Matteo Bonori.
Dear Maria Emerson, Editorial Coordinator, we have deeply appreciated the professionalism demonstrated by the International Journal of Clinical Case Reports and Reviews. The reviewers have extensive knowledge of our field and have been very efficient and fast in supporting the process. I am really looking forward to further collaboration. Thanks. Best regards, Dr. Claudio Ligresti
Dear Ms. Mayra Duenas, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. “The International Journal of Clinical Case Reports and Reviews represented the “ideal house” to share with the research community a first experience with the use of the Simeox device for speech rehabilitation. High scientific reputation and attractive website communication were first determinants for the selection of this Journal, and the following submission process exceeded expectations: fast but highly professional peer review, great support by the editorial office, elegant graphic layout. Exactly what a dynamic research team - also composed by allied professionals - needs!" From, Chiara Beccaluva, PT - Italy.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.
Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.
Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
