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Review Article | DOI: https://doi.org/10.31579/2693-4779/229

An Overview of Genetic Testing

  • Adil Mohamed Ali Hassan Ahmed 1
  • Nahla Widatalla Abdalla Hamrawi 2
  • Asma Ahmed Osman Mohamed 3
  • Mohamed Eltayieb Elawad 4
  • Abrar Bakry Malik 4*

1Manger Medical Services, Catrion Catering Holding Company.
2Histopathology registrar, Sudan Medical Specialization Board (SMSB).
3General practitioner. Burjeel Medical City.
4Administration and research, Elmalik Academy of Medical Research, Khartoum, Sudan
 

*Corresponding Author: Abrar Bakry Malik, 4Administration and research, Elmalik Academy of Medical Research, Khartoum, Sudan

Citation: Ali Elobaid SE, Mustafa Idris MY, Osman Mohamed AA, Elfaki Elamin EA, Ahmed Suliman SH, et al, (2024), An Overview of Genetic Testing, Clinical Research and Clinical Trials, 10(5); DOI:10.31579/2693-4779/229

Copyright: © 2024, Abrar Bakry Malik. 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: 17 August 2024 | Accepted: 05 September 2024 | Published: 08 October 2024

Keywords: genetic test; pharmacogenetic; DNA

Abstract

Since its emergence to the present day, genetic testing plays an essential role in many clinical aspects that include diagnosis, prevention and treatment. Development continues in genetic analysis as required by the latest genetic-related issues. In this review, we will discuss genetic testing techniques, the pivotal role they play in various clinical applications, and pharmacogenetic aspects of these tests.

Introduction

Genetic testing is the analysis of genetic proteins such as DNA, chromosomes or RNA related to genetic or inherited diseases. [1] Genetic tests are classified into diagnostic tests and predictive tests. Diagnostic tests are competent to support the diagnosis of genetic diseases with a clear clinical picture, while prediction of future susceptibility to genetic disorders is the responsibility of predictive tests. [1,2]

Genetic studies are developing at a rapid pace, particularly in recent years. It has become an integral part of many medical fields. As its spread expands, we find that it has many techniques, such as detecting illnesses related to genetic mutations, karyotype, and phenotype. [3]

Among many applications and purposes, genetic testing has a high profile in pharmacogenetics, ancestral proof issues, and inborn metabolic disorders. [4]

In this review, we will discuss genetic testing techniques, the pivotal role they play in various clinical applications, and pharmacogenetic aspects of these tests.

Principles And Techniques of Genetic Testing

Genome study is one of the emerging specialties in general, and in the medical field in particular. Over the time, human genome investigations have made remarkable progress at the levels of diagnosis, prevention and treatment.

Back in the past, genetic analyses began with conventional cytogenic techniques where it was reported that the number of human chromosomes was 48 and continued until 1956 when Tjio and Levan corrected that misconception, the number of the chromosomes was 46. [5] Then, peripheral leucocyte culture method was combined with the fixation and staining methods that paved the way for the identification of chromosomal dysfunction related to congenital abnormalities. [6] Three years after discovering the correct number of chromosomes, the same scientists described genetic imbalances in both chromosomes (Down syndrome, trisomy 21), and sex chromosomes (Turner syndrome, monosomy X: and Kleinfelter syndrome, XXY). [7-9] In 1966, genetic analysis evolved further into possible sampling of cells derived from amniotic fluid prior to the birth of the fetus through a procedure called "amniocentesis"; through which chromosomal abnormalities can be detected during embryonic life. [10] Ten years after the last development, chromosomal structural anomalies can be seen with high resolution using high-resolution banding technique by synchronized lymphocyte cultures. [11] Seeing chromosomal aberrations with high resolution opens the way for further progress in various genetic aspects, such as: knowing the genetic causes of numerous genetic syndromes (e.g., Cri-du-Chat syndrome), the possibility of a child being born with many embryonic anomalies in balanced genetic translocations in repeated abortions. In 1902, Poveri launched the theory of somatic mutations that explained the interconnectedness between cancer and chromosomal abnormalities, where it was shown that only one genetic mutation in the responsible proteins of cellular division and growth could cause cancer. [12]

In 1982, genetic analysis progressed further and it became possible to identify chromosomal anomalies that needed accuracy exceeding 500 and 1,000 bands, fluorescence in situ hybridization (FISH) that studied those anomalies at the molecular cytogenic base. [13] Contrary to the above, a group of scientists developed FISH technique where they used nonradioactive probe in direct and indirect ways to mark specific DNA sequences. [14] Later, many methodologies based on FISH technique were developed, for example: spectral karyotyping FISH (SKY-FISH), quantitative FISH (Q-FISH), fiber-FISH, heterochromatin-M-FISH, multicolor FISH (M-FISH), combined binary ratio labeling FISH (COBRA-FISH), centromere-specific M-FISH (cenM-FISH). [15-21]

One of the most prominent roles played by diagnostic clinical FISH tests is the detection of subtelometric errors (deletion and duplication) that are directly responsible for mental disability and many congenital defects.

Unfortunately, FISH techniques were not characterized by low cost and time saving. Therefore, array-based comparative genomic hybridization technique has been developed that has adopted the concept of comparing the hybridization between normal DNA and amplified tumor DNA in metaphase environment. [22-24] It enabled scientists to identify subtelometric errors with higher resolution. By contrast, the technique of comparing genome variation did not have the ability to detect the recessive disease genes, mosaic aneuploidy, uniparental disomy (UPD), or heterochromatic rearrangements. Because of this, it became inevitable that a higher resolution method would be developed and the result was the integration of SNB and CGH arrays. [25] The combined arrays technique is precisely superior 10 to 15 times than FISH technique, and the substrate is only DNA without needing metaphase chromosomes. [26]

At the beginning of the 1990s, polymerase chain reaction (PCR) emerged, which revolutionized the world of molecular genome techniques and made it easier to make millions of copies of specific DNA sequences. [27] Restriction fragment length polymorphism (RFLP) and single-strand confirmation polymorphism (SSCP) are the most used methods for diagnosing genetic mutations, yet they were unable to identify all mutations. This was skipped by Maxam-Gilbert chemical sequencing technology, which relied mainly on the chemical modulation of DNA followed by division in certain bases. [28] The latter did not last long because it cannot handle long PCR fragments, and its chemical risks. Maxam-Gilbert chemical sequencing technique was quickly replaced by a manual Singer sequencing method that centered around the concept of dideoxynucleotide chain termination. [29]

With the emergence of the Human Genome Project in the United States of America that demonstrated the entire sequence of the human genome and which in turn included about 25 thousand genes did not stop there. [30,31] The effect was extended to reveal new mutations associated with genetic diseases. Singer's manual technique was not commercial those developments in terms of cost and time which necessitated the development of a massively parallel sequencing (MPS) technique that opened the door for the diagnosis of many diseases, such as: malignant tumors, metabolic neurological diseases, and mental disability. [31]

Clinical Applications of Genetic Testing

As explained in the definition of genetic testing, it encompasses a broad spectrum of age groups. Genetic testing purposes also multiply to include crucial aspects in clinical medical applications, such as: prevention, diagnosis, and treatment.

Diagnostic genetic tests are often performed to confirm a disorder in a patient with a clinical picture likely to return to a genetic disease. DNA-based technologies are now the prevailing techniques for diagnosing Duchene muscular dystrophy by detecting the deletion of dystrophin gene. [32] The result of DNA tests is the point between merely a genetic diagnosis or the continuation of a biopsy. 30% of Duchenne muscular dystrophy patients may have a negative result due to the fact that the technique used (DNA-based techniques) may not detect the deletion of Dystrophin gene. [32] This proportion of patients falls under the umbrella of heterogeneity of alleles, which means that there are many different mutations in the same gene and all lead to the same disease. [33]. For example: mutations in BRCA 1 and BRCA 2 genes are closely associated with breast and ovarian cancers. [34]. Also, patients with thyroid medullary carcinoma with mutations in the oncogene RET shows that cancer is part of MEN-2. 85% to 95% of relatives of thyroid medullary carcinoma patients have positive results by testing RET oncogene mutations. [35-37] On the other hand, genetic disorders can occur as a result of only one mutation in specific genes, such as in sickle cell anemia, where a particular single mutation in the beta-globulin gene ensures that adult hemoglobin converts to hemoglobin S. [38] Usually, the genetic diagnosis of this disease is done through hemoglobin electrophoresis as can the use of DNA-based techniques. However, DNA-based techniques have the added advantage of being diagnostic in the prenatal period. [39]

In terms of chromosomal disorders diagnosis where the defect is in the form of translocation, deletion, duplication, loss of chromosomal segment, presence of additional chromosome, or rearrangement of chromosomes, genetic cytogenic tests are optimal. [40,41] FISH and fluorescent DNA probes technique related to it enables investigator to identify chromosomal micro-mutations and deletions, such as: 22q11 deletion syndrome which cause congenital heart disease, learning difficulties, and palate anomalies. [42-44]

In addition to the diagnostic value, genetic tests offer a prognostic benefit for genetic diseases. When genetic pathogenic mutations are detected in a family member, the rest of the household is likely to be at a different risk of developing the disease. This allows for preventive action. This concept is clearly in the case of mutations in the oncogene RET that lead to thyroid medullary carcinoma. The presence of these genetic mutations requires direct testing of other family members and thyroidectomy in those who share the genetic mutation with the original patient. [45,46] Also, the offspring of Huntington’s disease patients (autosomal dominant disorder causing motor and mental illness) are recommended to conduct genetic tests. Because there are mutations related to the disease, children are 100% susceptible to Huntington. [47] Unfortunately, until now there are no precautionary measures for this category. A pre-test consultation is therefore required to avoid negative psychological and societal effects. [47] In addition to medical reasons, genetic tests can be performed for personal decisions related to having children. In the case of autosomal recessive and X-linked diseases, the role of genetic testing is to identify the cases of carrier state. The incidence of genetic diseases varies depending on the type of defect. In autosomal recessive diseases (e.g.sickle cell anaemia) the rate of inheritance of the disease to the offspring is 25% provided that both mother and father are carriers of the disease. In the case of X-linked recessive disorders, carrier women can inherit 50% of each son. The precaution that can be followed when confirming a carrier state in the parents is to council them with the need for prenatal genetic testing that entails making a decision towards such pregnancy.

Doctors usually note that patients' response to the drug is different, some appear to respond at odds with expectations, and others may experience severe side effects. [48] We can attribute this variation among patients to the genetic factor, the enzymes responsible for drug metabolism, and lifestyle.

Cytochrome P450 is an enzyme containing heme responsible from metabolizing many compounds inside and outside the body. [49,50] Although it is controlled by approximately 57 cytochrome genes, CYP3A4, CYP2D6, and CYP2C9 are the most prominent ones in drug metabolism. [51] Cytochrome P3A5 is a component of the Cytochrome P3 group and is present in the kidneys, intestines, prostates, and liver. Also, it plays a reductive role in drug metabolism, so it can lead to varying responses among patients. [52] In the other hand, CYP2C9 and CYP2C19 genes act as an enzyme inhibitor leading to a declining metabolism of a range of drugs including sulfonyluria, warfarin, and phenytoin. The expression of these genes in some patients calls for reducing the doses of drugs affected by them, especially, warfarin whose accumulation leads to serious adverse consequences. [53]

Drug genetics play a pivotal role in the metabolism of many drugs, for example: azathioprine is an immunosuppressant used to treat autoimmune diseases and in organ transplantation. An enzyme thiopurine S-methyltransferase (TBMT) is responsible for his metabolism, which is made up of three non-functional alleles TPMT*2, TPMT*3A, and TPMT*3C. The prevalence of these alleles varies according to the ethnic group as the latter is the most prominent among Africans, while the second is the most common among Caucasians. [54] In cases of kidney transplant, these alleles can be associated together with azathioprine -related marrow suppression, but the category of patients with TPMT*3A high expression are subjected to life-threatening marrow failure. This requires reducing the dose of azathioprine when used for kidney transplant patients of Caucasian ethnicity. [55]

Also, asthma patients with mutations in 5-lipoxygenase-promoter region show a weaker response to lipoxygenase inhibitors. [56] The same concept applies to anti-hypertension, especially ACE inhibitors. Some patients with ACE insertion/deletion mutations have shown therapeutic responses different from those of patients they lack. [57] However, knowing the patient's pharmacogenetic and its association with the pharmacokinetic has become a given that must be considered to detail the drug at a dose that gives the best results with the least possible side effects.

Ethical Consideration of Genetic Testing

Since genetic tests will not stop at the point of confirming a diagnosis, but will go beyond to influence preventive and personal medical decisions, it is essential to provide comprehensive counselling to individuals or families who will undergo such tests. When genetic counselling is related to the development of clinical therapeutic plans, recommendation-based genetic counselling is the most appropriate. [58] If genetic testing has to be repeated here, no genetic counselling is required every time. However, genetic counselling is better not directed (i.e. the patient's ownership of all aspects of the disease that help him or her to make the appropriate decision of his or her own volition without giving recommendations), in cases of childbearing, and untreatable diseases. [59,60] Before taking the patient's consent to a genetic test, it is necessary to take into account the psychological, familial, and social effects that may result from it and to take the necessary precautions towards them. [61] In addition to the trade-off between the predictive value of the genetic test and its negative effect.

Conclusion

Since its emergence to the present day, genetic testing plays an essential role in many clinical aspects that include diagnosis, prevention and treatment. Development continues in genetic analysis as required by the latest genetic-related issues.

Acknowledgement

Elmalik Academy of Medical Research

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Virginia E. Koenig

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.

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Delcio G Silva Junior

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.

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Ziemlé Clément Méda

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.

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Mina Sherif Soliman Georgy

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.

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Layla Shojaie

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.

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Sing-yung Wu

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.

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Orlando Villarreal

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.

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Katarzyna Byczkowska

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.

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Anthony Kodzo-Grey Venyo

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.

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Pedro Marques Gomes

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.

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Bernard Terkimbi Utoo

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.

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Prof Sherif W Mansour

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.

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Hao Jiang

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.

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Dr Shiming Tang

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.

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Raed Mualem

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.

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Andreas Filippaios

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.

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Dr Suramya Dhamija

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.

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Bruno Chauffert

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!

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Baheci Selen

"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".

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Jesus Simal-Gandara

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.

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Douglas Miyazaki

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.

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Dr Griffith

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.

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Dr Tong Ming Liu

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.

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Husain Taha Radhi

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.

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S Munshi

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.

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Tania Munoz

“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”.

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George Varvatsoulias

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.

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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.

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Khurram Arshad

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.

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Gomez Barriga Maria Dolores

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.

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Lin Shaw Chin

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.

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Maria Dolores Gomez Barriga

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.

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Dr Maria Dolores Gomez Barriga

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¨.

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Dr Maria Regina Penchyna Nieto

Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.

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Dr Marcelo Flavio Gomes Jardim Filho

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!”

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Zsuzsanna Bene

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

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Dr Susan Weiner