AUCTORES
Globalize your Research
Case-Report | DOI: https://doi.org/10.31579/2641-0419/095
1 Nélio Mendonça Hospital, Avenida Luís de Camões, nº 57 – 9004-514 Funchal, Portugal.
*Corresponding Author: Marina Santos., Nélio Mendonça Hospital, Avenida Luís de Camões, nº 57 – 9004-514 Funchal, Portugal.
Citation: Marina Santos., Nuno Santos., Ricardo Rodrigues., Bruno Silva., António Drumond., (2020) Cannabis Induced Vasospasm Complicated By Iatrogenic Coronary Artery Dissection. J, Clinical Cardiology and Cardiovascular Interventions, 3(10); Doi:10.31579/2641-0419/095
Copyright: © 2020 Marina Santos, 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 October 2020 | Accepted: 19 October 2020 | Published: 26 October 2020
Keywords: cannabis; marijuana; acute myocardial infarction; coronary vasospasm; iatrogenic coronary dissection
Cannabis is the most abused psychoactive drug in the world. Delta 9-tetrahydrocannibol, the main psychoactive compound in marijuana, acts via the endocannabinoid system to elicit various cardiovascular physiological effects, and has been associated with many adverse cardiovascular effects such as acute coronary syndrome, arrhythmias, and sudden cardiac death. It is important to consider cannabis use as a significant risk factor of myocardial infarction, particularly in individuals with no cardiac risk factors, as delay in management can result in fatal outcomes.
Coronary angiography as the main exam to definitively diagnose or rule out coronary artery disease is usually safe, but complications also occur. Coronary dissection, despite rare, can be extremely difficult to manage and even be fatal. Iatrogenic causes of coronary dissection include catheter tip or guidewire trauma, vigorous contrast injection and angioplasty balloon overinflation.
We present the case of a 41 years old Caucasian woman admitted to cardiology department after an episode of myocardial infarction due to cannabis induced vasospasm. However, the angiography was complicated by iatrogenic coronary artery dissection.
Cannabis, also known as marijuana, is the most common psychoactive drug used worldwide, with rates of consumption expected to rise given increasing legalization for recreational and medical use [1]. Although cannabinoids are the oldest and most widely used drugs, its clinical and pharmacological effects have only been recently studied, with much still unknown about the physiologic and pathologic effects of marijuana. Much of the available data on 9-tetrahydrocannabinol (THC), the main psychoactive ingredient in marijuana, relates to its neurological effects and antiemetic properties, with little on the cardiovascular (CV) effects of THC [2, 3]. However, in the medical literature an association between cannabis and adverse CV events has been demonstrated.
Diverse cases of cannabis-related acute coronary syndrome have been reported, even in people with normal coronary arteries [4-5]. The current literature proposes that marijuana adversely affects the CV system
through three different possible mechanisms – cannabis-induced arteritis, vasospasm, and platelet aggregation [6-8].
A 41 years old Caucasian female presented to the emergency room (ER) with sharp precordial chest pain of three-hour duration accompanied by sweats and nausea. Also, she had an episode of vomit, with pain relief. She was currently taking oral birth control and denied other personal risk factors for ischemic heart disease. Family history was not significant for coronary artery disease or sudden cardiac death.
Upon presentation, patient was hemodynamically stable, and her physical examination was unremarkable. Electrocardiogram (EKG) revealed sinus rhythm at a rate of 98bpm with 1mm ST segment elevations in the V1-V3 and aVR leads and 1mm ST segment depressions in the V4-V6 leads (Figure 1).
Figure 1: EKG reveals sinus rhythm at a rate of 98bpm with QS wave and 1mm ST segment elevations in the V1-V3 and aVR leads and 1mm ST segment depressions in the V4-V6 leads.
High sensitivity cardiac troponin was initially positive (hs-cTnl 1.29mg/mL, reference value <0.014mg/mL) and up trended to a peak of 5.54mg/mL. A transthoracic echocardiography (TTE) showed anterior and apical hypokinesis with an estimated ejection fraction of 45%.
The patient was loaded with aspirin, ticagrelor and heparin and was referred for urgent coronary angiography. The first contrast dye injection revealed normal coronary arteries (Figure 2A).
However, after this injection, an anterograde spiral coronary dissection
appeared, extending from left main coronary artery (LMCA) to the distal portion of left anterior descending artery (LAD) (Figure 2B), which abruptly halted coronary flow, almost immediately resulting in cardiogenic shock. Treatment with vasopressors was promptly initiated. After a period of hemodynamic instability, she successfully underwent angioplasty of LMCA and LAD with 3 drug eluting stents (Figure 2C). She was transferred to the intensive coronary care unit (ICCU) for further monitoring and vasopressor agents could quickly be titrated down and stopped. Prompted she was transferred to cardiology ward.
Figure 2A: Angiography shows normal coronary arteries. B. An anterograde spiral coronary dissection extending from LMCA to the distal portion of LAD is visible. C. Flow restored after stent angioplasty of LMCA and LAD.
Despite progressive improvement, at nine day of hospitalization she developed a new episode of precordial chest pain and the EKG showed >3mm ST segment elevations in the anterior leads (Figure 3).
Figure 3: EKG shows sinus rhythm at a rate of 75bpm and >3mm ST segment elevations in the anterior leads.
Emergent coronary angiography revealed a proximal LAD pre-stent narrowing, probably dissection (Figure 4A). After successful LAD stent angioplasty, a circumflex artery (Cx) vasospasm resolved with intracoronary adenosine and nitroglycerine (Figure 4B/C)
Figure 4A: Coronary angiography reveals a proximal LAD pre-stent narrowing, probably dissection. B/C. After LAD stent angioplasty, a Cx vasospasm resolved with intracoronary adenosine and nitroglycerine.
Ticagrelor was switched to prasugrel an patient was again transferred to ICCU.
On further questioning, patient admitted a moderate consumption of cannabis for the last 6 months. Urine toxicology testing was positive for cannabis and negative for any other recreational drug. Subsequently the clinical course was uneventful. A pre-discharge TTE showed septal, anterior, and apical hypokinesis with reduced ejection fraction estimated at 38%. She was discharged home 15 days after admission. Post-discharge treatment included dual antiplatelet therapy (aspirin 100 mg daily and prasugrel 10mg) in combination with channel blockers, oral nitrates, and a statin.
Marijuana is the most common illicit substance used worldwide and the rate of usage is only increasing [1]. Cannabis is derived from the plant Cannabis sativa, with the main psychoactive constituent being 9- tetrahydrocannabinol (THC) [9-10]. The THC ligand has high selectivity for the Cannabinoid 1 and 2 receptors (CB1 and CB2, respectively). CB1 receptors, the primary targets of THC, are most abundant in the central nervous system, and are responsible for most CV effects via activation of the sympathetic nervous system (SNS). Those receptors are also located in some peripheral tissues, such as the heart and vascular endothelium [11-14]. CB2 receptors are found primarily in the immune tissues [15].
Different mechanisms have been proposed to explain the deleterious effects of cannabis on the heart. The most common cardiac manifestations of marijuana are a dose dependent increase in blood pressure and heart rate through cannabis-mediated activation of SNS [16-17]. Additional CV manifestations include increased myocardial oxygen demand and decreased oxygen supply due to elevation of carboxyhemoglobin [18-19]. Therefore, THC use has been associated with increased angina frequency.
While cannabis is well known to cause the effects described above, myocardial infarction (MI) or coronary vasospasm has rarely been described. In an epidemiological study to identify triggers of nonfatal MI, cannabis was shown to have a low population attributable factor of 0.8 (95% CI 0.38% to 1.67%); in comparison, cocaine use had an odds ratio of 24 [20]. Mittleman et al., in a case-crossover study found that cannabis use increases the risk of MI nearly five times within 60 min after use and confers a 1.5-3% annual risk of an acute CV event [21]. Reversible coronary vasospasm is considered the most common cause of cannabis- induced CV events [6]. While, the underlying mechanisms for this are still unclear, numerous case reports have associated THC with coronary vasospasm cardiomyopathy [22-25]. Mendizabal et al. reported that chronic marijuana use may result in autonomic nervous system dysfunction, which coupled with THC-induced irritation of the vascular endothelium could possibly explain the increased risk of vasospasm [26]. Also, the effects of cannabis induced vasospasm may be linked to THC induced mitochondrial disease in the acute coronary syndrome [3].
We present the case of a young female who, on admission, denied significant CV risk factors, besides oral birth control use. She presented symptoms and signs compatible with MI and, for that, she underwent coronarography. Initially no coronary lesions where observed, and a coronary vasospasm seemed to be the reason for the clinical picture. Unfortunately, during angiography, a coronary dissection developed. In general, iatrogenic causes of de novo dissection include catheter tip or guidewire trauma, vigorous contrast injection and angioplasty balloon overinflation [27]. Here, the procedure was performed via radial access, which requires more complex catheter manipulation than the femoral route, potentially increasing the risk of inadvertent catheter trauma. During hospitalization patient developed a new episode of MI and a second angiography was performed. After that vasospastic phenomenon became clearer and the patient confessed a regular cannabis smoking history. During hospitalization a new coronary angiography was done after a new episode of myocardial infarction and progression of the dissection in the LAD not covered by a stent was discovered. We believe that coronary vasospasm was the main responsible for the clinical picture, so the patient was medicated with nitrates and calcium channel blockers, with no pain recurrence.
Despite the symptoms here were typical, young adults with a long history of cannabis use may present with unusual clinical manifestations: recurrent episodes of nausea, vomiting, and abdominal pain. Those symptoms characterize the Cannabinoid hyperemesis syndrome, a rare medical entity observed in some long-term heavy cannabis users. While most patients usually complain of recurrent epigastric or periumbilical pain with negative investigations, the possibility of some serious cardiac event should not be neglected as cannabis seems also able to trigger coronary vasospasm in patients presenting with atypical pain or electrocardiographic changes [28].
This case illustrates the importance of recognition of vasospasm in patients taking marijuana. Myocardial infarction at a young age is unusual and drug-induced MI is gaining importance with increased use of recreational drugs. With the legalization of marijuana in certain, marijuana-related hospitalizations and ER visits are likely to increase. It is important for the clinicians to recognize the association of marijuana with CV events, namely coronary vasospasm, so a history of substance
abuse should be actively sought. Emergency physicians should consider this in the differential diagnosis of patients presenting with ischemic symptoms based on history and a urine drug screen. As this is a diagnosis of exclusion, these patients should be treated as acute coronary syndromes until proven otherwise by ischemia evaluation. However, with this case we also realize that angiography can be deleterious and cause de novo coronary dissection, a potentially fatal event if not treated immediately.
Authors declare no conflicts of interest.
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.
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.
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, 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.
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!”
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
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.
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 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.
