AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/2690-8794/023
1 Undergraduate Student of Medicine at UnP - Potiguar University - Laureate International Universities – Natal/Brazil;
2 Neurologist and Professor at Potiguar University / UnP - Laureate International Universities – Natal/Brazil;
3 Postgraduate Program in Biotechnology at Potiguar University / UnP - Laureate International Universities. Teaching and Research Manager - School of Health - League against Cancer Natal - RN / Brazil. Ph.D. in Health Science;
4 Postgraduate Program in Biotechnology at Potiguar University/ UnP - Laureate International Universities; Full Professor Department of Surgery, Federal University of Rio Grande do Norte. Full Professor, Department of Surgery, Potiguar University. Ph.D in Health Science/ Natal-RN, Brazil
*Corresponding Author: Irami Araújo-Filho, Postgraduate Program in Biotechnology at Potiguar University/ UnP-Laureate International Universities; Full Professor Department of Surgery, Federal University of Rio Grande do Norte. Full Professor, Department of Surgery, Potiguar Uni
Citation: Rebecca Renata Lapenda do Monte, Francisco de Assis Fernandes Tavares, Bruno Barreira Cardoso, Alyne Barreto Mesquita de Goes, Thais Cristina Loyola da Silva, Brenda de Oliveira Silva, Yara Saiane Marim Araujo, Amália Cinhtia Meneses Rêgo, Irami Araújo-Filho. Clinical Medical Reviews and Reports. 2(4); DOI: 10.31579/2690-8794/023
Copyright: © 2020, Irami Araújo-Neto. 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: 26 May 2020 | Accepted: 19 June 2020 | Published: 26 June 2020
Keywords: covid-19 pandemic; sars-cov-2 infection; coronavirus; central nervous system viral diseases; peripheral nervous system diseases; injury
The coronavirus pandemic transformed the world abruptly due to the speed of transmission and high morbidity and mortality. Many deaths have been quantified, and the scientific community intensifies the search for molecular targets, protein sequences and polymorphisms on SARS-CoV-2, to improve the clinical evolution and survival of patients. Initially, COVID-19 was described with respiratory changes, flu, and fever. With the spread of the disease, clinical manifestations were observed in other organ systems, still unknown. In this sense, the present study describes the main neurological changes and laboratory findings. The literature review was identified in the central databases: Scielo, Google Scholar, PubMed / MedLine, Embase, and Cochrane Database. Twenty-five articles related to the theme were chosen, including reviews, case series, cohort, and retrospective studies. Neurological manifestations were predominantly anosmia/hyposmia, dysgeusia, ataxia, and seizures. According to the latest published studies, attention must be paid to isolated initial neurological events.
The new coronavirus appeared in the city of Wuhan in China, and, due to its high infectivity, it spread quickly to the whole world. SARS-CoV-2 was responsible for the critical state of the pandemic that we are experiencing today. The clinical syndrome caused by SARS-CoV-2 was called COVID-19 [1, 2].
The signs and symptoms are clinically indistinguishable from those of the flu. Studies have described fever (43.8% on admission and 88.7% during hospitalization), cough (67.8%), fatigue (50%), headache (8%), and diarrhea (5%). However, the disease affects other organ systems and evolves with varied clinical manifestations [1,3].
In addition to changes in the respiratory system, patients with COVID-19 may have neurological syndromes, loss of involuntary breathing process, impairment of the brain stem, ataxia, loss of smell, seizures, among others. These manifestations are usually alarming and signal a worse prognosis [1].
Neurological changes seen in patients with severe infection include acute cerebrovascular events, impaired consciousness, areflexia, paraesthesia, and muscle injury [3].
As the emergence of the pandemic, the recognition of neurological clinical findings is in its early stages. Thus, little is known about the syndromic complexity of COVID-19. Still, it is believed that the neurological disorders of the disease are similar to the data previously described by the infection of SARS-CoV-1, a virus of the same family [3].
No vaccine or antiviral treatment specific to COVID-19 has yet been shown to be effective. For this reason, several preventive measures have been suggested to minimize the damage caused by the disease, personal protection, social distance, adequate hygiene measures, and isolation of confirmed cases. Identifying and treating patients as quickly as possible, especially patients considered to be at high risk, is crucial to reducing the mortality rate [4].
Mortality is higher among elderly patients and patients with comorbidities, including diabetes, cardiac, respiratory disorders, and immunosuppressed. [4]
This article describes the main neurological signs and symptoms reported in the literature and correlates these findings with etiopathogenic mechanisms, laboratory tests, and prognostic factors.
The present study was carried out based on searches in PubMed / Medline, Scopus, Scielo, Embase, and Web of Science databases in addition to the Google Scholar search, considered as a source of gray literature, as it does not contain peer-reviewed articles. Studies related to neurological manifestations of the coronavirus were selected, being chosen through the combination of the following keywords: neurological signs and COVID-19. All relevant studies published between 2019 and 2020 were included in the cohort, systematic review, case-control, cross-sectional, case series studies, and randomized clinical trials. The filters chosen were studies carried out in humans, complete articles, and recently published, totaling twenty-five articles. analysis, review, and selection of the articles were made by peers blindly, from reading the title and summary of the study, with a third reviewer in case of disagreement between the other two reviewers.
The coronavirus family comprises viruses that cause diseases with different clinical manifestations, which can vary from a common cold to severe clinical conditions. SARS-CoV-2 is the new coronavirus, first detected in China and spreading globally [1].
The average age of onset is 35-55 years of age, with a lower prevalence in children. Most patients are male, and the main risk groups are immunosuppressed patients with renal and hepatic dysfunction. Transmission can occur through droplets, aerosols, and contaminated surfaces, when in contact with the mouth, nose, or eyes of susceptible individuals. There is an increase in the number of cases transmitted through the feces of infected patients [5].
To date, there is no specific consolidated treatment regime for COVID-19, which is why the importance of symptomatic management is essential. Thus, atypical symptoms must be taken into account during anamnesis and physical examination of patients, since the evolution of the disease, in these cases, can be more severe. Patients may experience respiratory, digestive, liver problems, and disorders of the nervous system [6-8].
Nath A. el al. subdivided these into manifestations that occur at the time of infection and post-infection events. Encephalopathy, hypoventilation, viral meningitis, anosmia, ageusia, encephalitis, stroke, myositis, and acute hemorrhagic encephalopathy are parainfectious symptoms. Transverse myelitis, Guillan-Barré syndrome, sensory neuropathy, brainstem encephalitis, and acute transverse encephalomyelitis, usually occur after COVID-19 infection [7-9].
Health system
The measurement of neurological disorders based on signs and symptoms, as well as the patients' prognosis, can be assessed through the protocol developed by the World Health Organization (WHO) in February 2020. In this, respiratory findings are addressed; however there is a specific column to detect the neurological aspects involved [8,9].
It is important to note that these clinical presentations are being released to the world in real-time by the number of "First Few X cases (FFX) and their close contacts" by WHO. Several cases have been described, with nonspecific manifestations such as loss of smell, headache, seizures, and hemiparesis [8,10].
Pathophysiology
SARS-COV and MERS-COV have neuro-invasive properties, which can be detected in the human brain [9]. The pathophysiology of the lesions has not yet been clarified concerning COVID-19; however, it is believed that it occurs via hematogenous, reaching the Central Nervous System (CNS) or by retrograde neuronal dissemination, due to the proximity of the cribriform plate of the ethmoidal bone. Depending on this theory, there is a report of hyposmia in several patients [11].
Also, it is known that the primary target cells for SARS-CoV-2 are the epithelial cells of the respiratory and gastrointestinal tract, which contain the angiotensin-converting enzyme 2 (ACE2), which is also present in the CNS and skeletal musculature. This enzyme is usually used by the virus to invade cells, for which it presents tropism [2, 10-12].
Inhalation of SARS-CoV-110 or MERS-CoV-11 resulted in the rapid invasion of viral particles in the brain, possibly through the olfactory bulb via the trans-synaptic route. Several viruses penetrate this pathway into the peripheral nerves and spread through the CNS through synaptic contacts [5-7].
The brain stem, where the neuronal respiratory bulb is located in the medulla, has been severely infected by both types of viruses, which can contribute to respiratory failure. On the other hand, it was observed that when nasal viral loads were inhaled in low concentrations, only the CNS was colonized, with the absence of viruses in other tissues, including the lungs, corroborating the existence of the neurotropism of the coronavirus strains by the CNS [2-4].
Due to retrograde neuronal dissemination, Li et al. advocate that the use of protective masks and antiviral drugs at the beginning of the disease should be encouraged to prevent CNS involvement [11-13]
A severe complication of COVID-19 infection is Acute Disseminated Encephalomyelitis, a syndrome described in patients with HCoV-OC43, which occurs approximately two weeks after infection. This syndrome is also expected to happen in SARS-CoV-2 [7,14].
The presence of the virus in the brain stem can affect chemosensory neural cells associated with respiratory and cardiovascular regulation, as well as neurons in the bulbar respiratory center (brain stem), affecting ventilatory lung function. An additional factor to the hypothesis that the nasal route may contribute to the entry of the virus in the brain is provided by clinical observations of anosmia, a new and profound mark in individuals infected with SARS-CoV-2 [1-3].
The infection by SARS-CoV-2 in the CNS triggers an intense systemic inflammatory reaction with a massive release of cytokines, chemokines, and other inflammatory mediators, with subsequent breakdown of the blood-brain barrier and amplifies the viral neuro-infection process [15-17].
The higher the plasma concentration of cytokines, the greater the need for intensive care. Pre-clinical and clinical studies have shown that systemic inflammation promotes neuroinflammation that severely affects cerebral homeostasis and causes the death of central and peripheral neurons [2, 11, 12].
Neurological symptoms
According to Baig et al., COVID-19 and SARS-CoV-1 have similar taxonomy. SARS-CoV-1 promotes neurological deficits and has already been isolated in brain tissue. In this sense, the coronavirus is expected to follow the same trend [3].
Neurological manifestations are classified into two categories: those that affect the Central Nervous System (CNS) and those that affect the Peripheral Nervous System (PNS). Clinical findings related to the CNS include vertigo, headache, impaired consciousness, acute vascular brain disease, ataxia, and epilepsy. SNP involvement causes hyposmia, neuralgia, and hypogeusia [13,18].
As for SARS-CoV-2, there is no exact description of what signs and symptoms to investigate or which neurological tests are indispensable in the physical examination of patients, as some, such as hyposmia and hypogeusia, are usually so mild that they are not present in most of the cases [19-20].
However, if there is a report or the presence of deficits, it is essential to perform laboratory tests, such as urea, creatinine, electrolytes, and blood gas analysis (PO2 and PCO2), as the results can corroborate for a possible primary or secondary involvement of the CNS. [3, 14]
The American Academy of Otorhinolaryngological Surgery (AACO) recently released that patients with COVID-19 may experience dysgeusia or hyposmia. These are the primary evidence that should be researched. It is believed that the virus causes inflammation in the olfactory nerves, instead of damaging the structure of the receptors, as the olfactory system can always fight pathogens and their dysfunctions are temporary. Generally, these same patients experience loss of taste [3, 15].
Based on the cases reported by AACO, it is recommended to investigate COVID-19 if the patient says anosmia, hyposmia, or dysgeusia in the absence of other respiratory diseases, such as acute or chronic rhinosinusitis and allergic rhinitis. The “COVID-19 Anosmia Report Tool for Clinicians” was made available by AAO-HNS to facilitate this diagnosis [15,16].
Anosmia is mostly transient, but it has been seen that in some patients, it has become permanent. As the lesion occurs due to invasion of the olfactory pathways, the monitoring of these patients should be encouraged for an extended period, to ensure that other neuroinflammatory diseases can be ruled out [7,21].
The meningitis clinic is controversial, as some studies report that neuronal deaths with inflammation of the brain substance have not been detected. However, Wu et al. report a case from Hospital Beijing Ditan, identified employing the genomic sequencing technique of the presence of SARS-CoV-2 in the cerebrospinal fluid. The patient was diagnosed with viral encephalitis, and SARS-CoV-2 attacked the central nervous system. The virus has mechanisms of direct invasion to the nervous system, in addition to the immune response to the pathogen [3, 9, 10]
It is inquired about the acute toxic viral encephalitis syndrome, from manifestations such as headache, consciousness disorder, and cerebral edema seen in autopsies. Thus, it is necessary to analyze the CSF of patients with these manifestations in search of the viral genome and inflammatory cells. [4-6,10]
In Japan and China, two cases of meningoencephalitis and encephalitis have been reported, respectively. Both had generalized seizures and acute respiratory distress syndrome. One of them presented lesions in the temporal lobe with adjacent ventriculitis and injuries in the paranasal sinuses [16-18].
The exciting thing was that the virus could be isolated in the CSF, but it was not detected in the nasal swabs. However, it is essential to emphasize that CSF should only be collected in cases where neuroimaging tests do not clarify the patient's symptoms or in cases of infectious or autoimmune processes [7,19].
In a series of cases with 214 patients, neurological symptoms were observed in 36.4%, being more common in patients with severe respiratory status (45.5%), with reports of acute cerebrovascular events, impaired consciousness, and muscle injury [1,3].
In patients described with severe infection, 5.7
In conclusion, SARS-CoV-2 can affect the central or peripheral nervous system. Patients affected by COVID-19 associated with neurological clinical manifestations evolve with greater severity. Thus, health professionals must know the atypical signs of the disease, as patients who do not have accompanying respiratory symptoms are considered a critical hidden source of the virus's spread.
Therefore, immediate diagnostic suspicion and early identification of these patients is necessary to contain the viral transmission, avoid clinical deterioration, and reduce mortality rates. The primary purpose of this review was to assist professionals in investigating neurological changes since the onset of the condition, avoiding an increase in the transmissibility of the disease and worse clinical outcomes.
The authors thank the Ph.D. in Health Sciences and Teaching and Research Manager at League Against Cancer, Profa. Dra. Amália Rêgo, for her contribution and relevance to the scientific discussion and supervision of this review, acting as an expert consultant on the bibliographic survey, analysis, and scientific advice. We also thank all the study components for their dedication and effort to build a scientifically validated quality study.
Disclosure of conflict of interest
There are no conflicts of interest to declare by any of the authors of this study.
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.
