AUCTORES
Globalize your Research
case report | DOI: https://doi.org/10.31579/2692-9392/129
1Professor and Head/Senior Consultant Physician, Department of Medicine/ Department of Nephrology, Defence Services Medical Academy/ No. (1) Defence Services General Hospital (1000-Bedded)
2Consultant Physician, No. (1) Defence Services General Hospital (1000-Bedded)
3Consultant Radiologist, No. (1) Defence Services General Hospital (1000-Bedded)
4Consultant Hematologist, No. (1) Defence Services General Hospital (1000-Bedded)
5Consultant Pulmonologist, No. (1) Defence Services General Hospital (1000-Bedded)
6Pulmonology Fellow, No. (1) Defence Services General Hospital (1000-Bedded)
7Assistant Lecturer / Consultant physician, Defence Services Medical Academy
8Physician, No. (1) Defence Services General Hospital (1000-Bedded)
*Corresponding Author: Khin Phyu Pyar, Professor and Head/ Senior Consultant Physician, Department of Medicine/ Department of Nephrology, Defence Services Medical Academy/ No. (1) Defence Services General Hospital (1000-Bedded), Myanmar
Citation: Khin Phyu Pyar, Sai Aik Hla, Soe Min Aung, Soe Win Hlaing, Zar Ni Htet Aung. et all (2022). A 32-Year-Old Dental Surgeon Presented with Massive Hemoptysis, Fever and Hypotension As A Result of Bleeding from Bronchiectasis due to Pulmonary Tuberculosis (New Case) with Concurrent Covid-19 Infection Successfully Treated with Anti-Tubercular Therapy (Isoniazid, Rifampicin, Ethambutol and Pyrazinamide): A Case Report on two Epidemic Disease. J. Archives of Medical Case Reports and Case Study, 6(2); D
Copyright: © 2022 Khin Phyu Pyar, This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 25 May 2022 | Accepted: 30 June 2022 | Published: 08 July 2022
Keywords: hemoptysis; COVID-19; tuberculosis; bronchiectasis
A dental surgeon had sudden onset of massive hemoptysis with hypovolemic shock during COVID-19 epidemic; her nasopharyngeal swab for SARS-CoV-2 PCR was positive. She noticed 2 days history of fever and cough; however, she had poor appetite for nearly two weeks. Resuscitation was done successfully with fluids and blood transfusion. Chest radiograph showed opacities in left lower zone; and, NECT chest revealed consolidation in left lower lobe and patchy opacities in right upper lobe with areas of bronchiectasis. Sputum for gene expert for drug resistant tuberculosis, Ziehl Neelsen stain for acid fast bacilli and Lowenstein Jensen media for culture could not be done as microbiological services were limitted in the peak of COVID-19 pandemics. Therefore, anti-tubercular therapy (isoniazid, rifampicin, ethambutol and pyrazinamide) was initiated mainly based on NECT chest without sputum confirmation; the patient made dramatic improvement. Two months later, she gained 10 lbs weight; and radiological improvement.
Covid-19 pandemic has had devastating effect on tuberculosis care; therefore, tuberculosis epidemic has been worsening (Pai et al., 2022). According to the World Health Organization’s 2021 Global TB report, the COVID-19 pandemic has reversed years of global progress in tackling tuberculosis and for the first time in over a decade, TB deaths have increased (World Health Organization, 2021). Here was a noticeable drop in tuberculosis case detection during the COVID-19 pandemic (Bardhan et al., 2021).
One report from meta-analysis revealed that people with tuberculosis are not more likely to get COVID‐19, but pre‐existing tuberculosis has a higher chance of developing serious complications from COVID‐19 (Gao et al., 2021). Regarding the treatment, the potential role of drugs prescribed during the initial phase to treat COVID-19 and their interaction with anti-TB drugs require caution (Visca et al., 2021). In countries where risk factors for mortality are highly prevalent among young individuals (smoking, alcohol and substance abuse, HIV co-infection, among others), particularly in the presence of drug resistance and difficult access to diagnosis (delayed diagnosis), the impact of mortality may be higher. We agree that, in resource-limited settings, poverty and malnutrition might play an important role in increasing morbidity and mortality (Tadolini et al., 2020). TB should be considered a risk factor for severe COVID disease and patients with TB should be prioritised for COVID-19 preventative efforts, including vaccination (The TB/COVID-19 Global Study Group, 2021). The study from China suggested that a moderate level of evidence suggests that COVID-TB patients are more likely to suffer severe disease or death than COVID-19 patients. Finally, routine screening for TB may be recommended among suspected or confirmed cases of COVID-19 in countries with high TB burden . Due to the ongoing pandemic, healthcare workers have been diverted to activities implemented for effective COVID-19 management, leaving a meager workforce to help deal with TB management (Song et al., 2019).
During COVID-19 pandemic, all patients with respiratory symptoms were presumed as COVID-19 infection; however, hemoptysis was relatively rare. The causes of hemoptysis in patients with COVID-19 infection are pulmonary embolism and infarction, secondary bacterial pneumonia, DIC and pulmonary oedema.
In pulmonary embolism and infarction, the sputum color is prune juice; and it is associated with chest pain which is pleuritic in nature. Pleural rub may be audible on auscultation. Chest radiograph may be normal. CT pulmonary angiogram is gold standard investigation; nevertheless, it is not easy to do in poor resource settings. High D dimer level is a good clue for diagnosis.
If the COVID-19 patient has secondary bacterial pneumonia, his sputum is mainly purulent which may be mix with blood. Patient may have neutrophil leucocytosis. Sputum for gram stain and culture may reveal organism though most of the microbiological lab are afraid of COVID-19 infection.
If hemoptysis is due to DIC, the patient may show other evidence of DIC like petechiae in skin and mucosal bleeding: epistaxis, gastrointestinal bleeding, hematuria etc. Blood tests may show anaemia, low platelet count, prolong prothrombin time and prolong APTT. The patient may have severe features of COVID-19 pneumonia like ARDS, low SaO2, hypotension and very high inflammatory markers such as CRP, ferritin, LDH, and liver enzymes.
Pulmonary oedema in patient with COVID-19 infection is poor sign; it results from acute coronary syndrome, myocarditis, acute renal injury and fluid overload. The sputum is typically pink frothy; patient is in severe dyspnoea. Physical examination reveals tachycardia, cyanosis, triple rhythm and fine basal crackles. Chest radiograph reveals upper lobe dilatation with hilar haziness; it is contrary to typical changes in COVID-19 pneumonia- mainly lower zone peripheral shadows. Blood for pro-BNP may be high.
A 32-year-old woman, a dental surgeon, had low grade fever and dry cough for 2 days. Then she noticed reddish blood in her sputum following some tickling sensation in throat in one evening. She continued to cough with increasing amount of fresh blood, 1,000 cc over an hour. Then, she felt giddy and also fainted. Her friends brought her to hospital at 02:00 hour. At emergency department, her blood pressure was 50/30 mmHg; pulse was thready 160/minutes. Extremities were cold and clammy. Resuscitation with saline and blood transfusion. Blood pressure became 100/60 mmHg, pulse rate 110/minutes after replacing 3.0 liters with saline and blood transfusion two units.
Blood for complete picture reveals as follows; hemoglobin 12.3 gm%, total WBC count 4.84 x 109 /L and platelet 164 x 109 /L. Absolute Neutrophils count was normal 4.19 x 109 /L; absolute Lymphocyte count was low 0.5 x 109 /L. CRP was high 18.25 mg/L (less than 5 mg/L). Liver enzymes were normal; AST and ALT were 17 IU/L and 21 IU/L respectively. Alkaline phosphatase was normal 63 IU/L. Serum creatinine was normal (0.7 mg%); electrolytes too (Na 137 mmol/L, K 3.7 mmol/L, Cl 99 mmol/L). Random blood sugar was normal. Retroviral serology was negative. Her nasopharyngeal swab for SARS-CoV-2 PCR was positive. She denied history of pulmonary tuberculosis; however, she had poor appetite for nearly two weeks.
Chest radiograph showed mild patchy opacities in left upper zone and upper zones were clear. (Figure 1) NECT chest revealed consolidation in left lower lobe and patchy opacities in right upper lobe with bronchiectasis. (Figure 2, 3, 4, 5).
They were highly suggestive of tuberculosis. Sputum culture, Ziehl Neelsen stain for acid fast bacilli and Lowenstein Jensen media culture for acid fast bacilli, Gene expert tests for drug resistant tuberculosis were out of service in the peak of COVID-19 pandemics. Thus, empirical anti-tubercular therapy (isoniazid, rifampicin, ethambutol and pyrazinamide) was initiated without microbiological confirmation. Hemoptysis subsided gradually. Two months after anti-tubercular therapy, the patient gained 10 lb weight. Chest radiograph was almost normal. NECT showed marked improvement.
During COVID-19 pandemic, all patients with respiratory symptoms were presumed as COVID-19 infection; however, hemoptysis was relatively rare. The causes of hemoptysis in patients with COVID-19 infection are pulmonary embolism and infarction, secondary bacterial pneumonia, DIC and pulmonary oedema; they have peculiar clinical features.
In pulmonary embolism and infarction, the sputum color is prune juice; and it is associated with chest pain which is pleuritic in nature. Pleural rub may be audible on auscultation. Chest radiograph may be normal. CT pulmonary angiogram is gold standard investigation; nevertheless, it is not easy to do in poor resource settings. High D dimer level is a good clue for diagnosis.
If the COVID-19 patient has secondary bacterial pneumonia, sputum is mainly purulent which may be mix with blood. Patient may have neutrophil leucocytosis in full blood count. Sputum for gram stain and culture may reveal organism though most of the technicians from microbiological lab are afraid of COVID-19 infection.
If hemoptysis is due to DIC, the patient may show other evidence of DIC like petechiae in skin and mucosal bleeding: epistaxis, gastrointestinal bleeding, hematuria etc. Blood tests may show anaemia, low platelet count, prolong prothrombin time and prolong APTT. The patient may have severe features of COVID-19 pneumonia like ARDS, low SaO2, hypotension and very high inflammatory markers such as CRP, ferritin, LDH, and liver enzymes.
Pulmonary oedema in patient with COVID-19 infection is poor sign; it results from acute coronary syndrome, myocarditis, acute renal injury and fluid overload. The sputum is typically pink frothy; patient is in severe dyspnoea. Physical examination reveals tachycardia, cyanosis, triple rhythm and fine basal crackles. Chest radiograph reveals upper lobe dilatation with hilar haziness; it is contrary to typical changes in COVID-19 pneumonia- mainly lower zone peripheral shadows. Blood for pro-BNP may be high.
Common causes of massive hemoptysis are bronchiectasis, lung abscess, pulmonary aspergilloma; all cab be visualized in NECT chest.
During COVID-19 pandemic, National Health System mainly focuses on COVID-19 infection: awareness for early diagnosis, isolation and treatment at COVID-19 designated hospital. The aim is to give appropriate treatment to patients with COVID-19 infection. In addition, protection of health care personnel is uttermost important. Moreover, prevention of non-COVID inpatient cases from acquiring COVID-19 infection is also essential. Therefore, other common infectious diseases like tuberculosis were not in the first list; this case highlighted the importance of awareness of pulmonary tuberculosis in COVID-19 pandemic. We are facing the battle against the two epidemic diseases COVID-19 infection (new one) and pulmonary tuberculosis (old one); the main reason for presenting this case.
The clinical presentation of concurrent tuberculosis and COVID-19 infection made the differential diagnosis difficult. The patient had fever and cough for 2 days only; it pointed acute infection rather than chronic one. However, the patient had appetite loss for 2 weeks; the clue for tuberculosis. Moreover, the occupation being a dental surgeon was a high risk for pulmonary tuberculosis.
Diagnosing tuberculosis during the COVID-19 pandemic requires a high index of clinical suspicion because the two diseases have similar characteristics, such as fever and respiratory symptoms.In full blood count, the patient had significant lymphopenia; the possibilities were both severe COVID-19 infection and tuberculosis.
In chest Xray, there was patchy opacities in left lower zone; the likely aetiology was COVID-19 infection. It was against pulmonary tuberculosis; the common site was upper zone.
Nonetheless, NECT chest gave the final decision. The presence of multiple bronchiectasis indicated the possible source for massive hemoptysis. And having multiple patchy opacities in right upper lobe explained the most likely aetiology- tuberculosis. In addition, areas of consolidation in the left lower zone in the presence of apical lesion on right side supported the most likely aetiology- tuberculosis. In countries with a high tuberculosis burden, the possibility of a concomitant diagnosis of tuberculosis and COVID-19 should always be considered in order to ensure the appropriate management of both diseases.
Another learning point was that NECT chest was mandatory if the chest Xray was normal in patients with hemoptysis. It is important information in poor resource setting. Furthermore, the presence of multiple bronchiectasis indicated the possible source for massive hemoptysis as well as the chronicity of disease- tuberculosis; the patient had tuberculosis for several months though the history of appetite loss was only two weeks. Thus, it pointed out the importance of awareness of asymptomatic tuberculous infection in developing countries.
In the era of drug resistant tuberculosis (multi-drug resistant or extended drug resistant), doing sputum for gene expert test is essential. If possible, sputum culture for drug resistant tuberculosis should be done in all cases. COVID-19 pandemic has had a significant impact on the diagnosis and treatment of tuberculosis. This patient, being health care worker, was a likely case of drug resistant tuberculosis. Because of logistic problem, we did not have microbiological evidence. Nevertheless, the patient had both clinical and NECT chest improvement after two months of anti-tubercular therapy. It highlighted the importance of clinical and radiological acumen of treating physician.
Having multiple bronchiectasis near right cardiac border was commonly due to atypical mycobacterium tuberculosis which required different drug regimen as a treatment (Lee et al., 2013). The major cavities in NTM disease generally have thinner and more even walls than those in TB. According to Kim et al. (2017), “when cavities are associated with adjacent pleural thickening, ill-defined satellite tree-in-bud nodules, or fewer non-cavitary nodules ≥ 10 mm, these CT findings are highly suggestive of NTM disease rather than TB” (Kim et al., 2017). This patient had ill-defined satellite tree-in-bud nodules; however, having clinical and radiological improvement was against atypical tuberculosis; another reason for reporting case.
The combination of tuberculosis and COVID-19 has great potential for morbidity and mortality. Patients with tuberculosis and COVID-19 may be at a greater risk of poor outcomes and death than are those with COVID-19 alone (Dave et al., 2021). One study showed that the risk of death was 2.17 times higher in patients with tuberculosis and COVID-19 than in those with COVID-19 only (Sy et al., 2020). Therefore, early detection of the combination is important for the proper management of both diseases. In this patient, we detect the diagnosis early; moreover, the response to anti-tubercular therapy was very dramatic.
Prioritization of treatment in patients with tuberculosis and concomitant COVID-19 infection is not easy. If the patient had severe COVID-19 infection, anti-viral therapy and anti-inflammatory drugs (steroids) would be first choice; the untoward effects would be exacerbation of tuberculosis. On the other hand, If the patient had mild COVID-19 infection, he did not require anti-viral therapy and anti-inflammatory drugs (steroids); he might need symptomatic drugs like anti-pyretics. In this patient, COVID-19 infection was mild as evidenced by minimal chest radiographic changes with mildly raised CRP with normal liver enzymes; thus, anti-tubercular drugs became first treatment of choice.
Common things are always common even in COVID-19 pandemics. Awareness of pulmonary tuberculosis is important in patient with hemoptysis. A high index of clinical suspicion is essential as two diseases- pulmonary tuberculosis and COVID-19 infection have similar characteristics, such as fever, respiratory symptoms and lymphopenia. Good clinical acumen is necessary for treatment. NECT chest is mandatory inpatients with hemoptysis.
Acknowledgements
The authors would like to thank the patient for giving consent to this article. Also, to all doctors and nursing team for making great efforts in caring him. The authors acknowledged the following team; Professor Ohmar Hlaing and team for radiology support, Professor Myint Zaw, Professor Kyaw Zay Ya and Professor Ko Ko Lwin for administrative support.
Declaration of conflict of interest
The authors declared no potential conflicts of interests with respect to authorship and publication of this article.
Ethical approval
Our institution does not require ethical approval for reporting cases.
Funding
The authors received no financial support for publication of this article.
Informed consent
The informed consent for publication in this article was obtained from husband of patient.
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.
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.
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 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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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 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.
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.
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.
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.
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!
"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 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 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 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.
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 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.
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.
“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”.
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.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
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.
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, 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.
