AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/2578-8868/036
1 Dr George Mukhari Academic Hospital, Sefako Makhatho Health Sciences University, Pretoria, South Africa
*Corresponding Author: Adrian Kelly, Dr George Mukhari Academic Hospital, Sefako Makhatho Health Sciences University, Pretoria, South Africa,
Citation: Adrian Kelly, Patrick Lekgwara.Cranial injuries secondary to community mob assault, J Neuroscience and Neurological Surgery. Doi: 10.31579/2578-8868/036
Copyright: © 2018 Adrian Kelly. This is an open-access article distributed under the terms of The Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 29 August 2018 | Accepted: 05 September 2018 | Published: 10 September 2018
Keywords: Traumatic brain injury; Community assault; Group assailants
Background: Community mob assault is a significant social problem in the townships of South Africa. We aimed to evaluate the prognostic variables associated with cranial injuries secondary this mechanism of injury over a 2 year period in patients referred to a single Neurosurgical center.
Materials and methods: Descriptive cross-sectional data analysis of cranial injuries following community mob assault, from January 2015 to December 2016, was performed. Medical records were analyzed in terms of patient demographics and the subsequent continuity of care from initial patient referral to eventual discharge. The Outcome measure utilized was the Glasgow Outcome Scale (GOS).
Results: Of the 41 patients treated, 100% were male. Mean age was 30.5 +/-9.1 years. No statistical significance was demonstrated between age and GOS (p=0.94). Socioeconomic status revealed that 33 (81%) were unemployed and 8 (19%) were employed. Alcohol involvement was confirmed in 14 (34%) of subjects and excluded in 3 (7%) of subjects, however in 24 (58%) of subjects this was unknown. Only 3 (7%) of subjects has isolated head injuries while 38 (93%) had additional injuries. Severity of head injury analysis showed that 15 (41%) presented with mild head injuries, 20 (49%) presented with moderate head injuries, 5 (2.4%) presented with severe head injuries and 1 patient presented with a critical head injury. Statistical significance was demonstrated with outcome (p=0.02). Site of head trauma recorded showed that 11 (37%) of subjects had isolated parietal injuries, 9 (30%) had isolated frontal injuries, 4 (13%) had base of skull fractures and 5 (17%) had multiple sites of cranial injury. CT features showed that 9 (26.4%) of subjects had an acute subdural hematoma, 8 (24%) of subjects had an extradural hematoma, 7 (21%) of subjects had an intracerebral contusion and 4 (12%) had cerebral edema. At discharge 6 (14.5%) of subjects were GOS 1, 10 (24%) were GOS 3, and 6 (15%) were GOS 4. Only 19 subjects (46%) were GOS 5 at discharge.
Conclusion: The study revealed that secondary to Community mob assault 39% of subjects either demised or are so disabled they are dependent in their daily life due to physical or mental disability. Less than half (46%) of subjects resumed normal life post community mob assault. The severity of the head injury was found to be statistically significant in predicting outcome.
Patients admitted to the Neurosurgical unit at our institution post Community mob assault are commonly severely injured and a considerable proportion of this group ultimately have an unfavorable outcome. Various factors such as poverty; socioeconomic inequality; perceived police injustice; and dissatisfaction in the reconciliation of a discriminative historical legacy have resulted in township communities increasingly deciding to take the law into their own hands. This community vigilantism constitutes an increasing social problem that carries with it not only significant consequences for the victimized individual and their family, but also places a considerable burden on limited hospital resources. While the link between socioeconomic stratification and risk of suffering a traumatic head injury post assault requiring admission has been confirmed, further analysis has also shown geographic clustering in poorer communities increases risk when compared to more affluent communities [1]. There is currently no South African literature that exclusively considers the Neurosurgical outcomes of this patient group. The aim of this article is to highlight the serious head injuries associated with this mechanism of injury as well as document the neurological consequences these victims commonly face.
We analyzed cranial injuries secondary to community mob assault with reference to patient demographics, patient presentation, pattern of injury, and Glasgow Outcome Scale (GOS) at discharge in a series of patients treated at a single neurosurgical unit situated in the province of Gauteng, South Africa, over a 2 year period.
Methods and materials
This is a retrospective chart review of patients with cranial injuries as a result of community mob assault presenting to the Department of Neurosurgery at Dr George Mukhari Academic Hospital located located in Pretoria, Gauteng, South Africa. The study period was from January 2015 to December 2016. The study was granted approval by the Medical Research Ethics Committee of the Sefako Makgatho Health Sciences University reference SMUREC/M/38/2017:PG.
A total of 246 patients were referred to our Neurosurgical Unit during this period with traumatic brain injuries secondary to assault, of which 41 (17%) had been victims of community mob assault. In terms of referral of this community mob assault sample, 16 (39%) were referred from local hospitals, 8 (19.5%) were referred from local clinics, and 17 (41%) were referred from the scene of the assault. Our institutional policy keeps record whether a patient is employed or not for the process of billing as well as a patient’s mechanism of referral. The referral doctor’s letter or the attending Trauma doctor’s assessment records whether the patient was intoxicated with alcohol at the time of presentation. In the same Emergency department the patient receives a full assessment and emergency treatment of their injuries. If indicated this includes a CT scan of their brain.
At our center these patients are commonly jointly managed by the Trauma department and the Department of Neurosurgery in view of the concomitant injuries these patients often incur requiring interdisciplinary care. The post resuscitation Glasgow Coma Score (GCS) is used to grade the severity of the head injury and is a corner-stone in our Neurosurgical evaluation of these patients. All patients with a GCS of 14/15 or below with/without the presence of an intracranial abnormality, and all patients with an intracranial abnormality on CT scan are admitted at our institution.
Patients with skull fractures are managed according to standard Neurosurgical principles namely elevation of closed depressed skull fractures or debridement and craniectomy of compound depressed skull fractures. Wound sepsis at presentation is a rarity as our patients are acutely referred and in the study population of 246 patients with traumatic brain injury (TBI) secondary to assault only 6 (2.4%) presented with wound sepsis. In the study sample of the 41 subjects whom incurred TBI secondary to community mob assault no patients presented with wound sepsis during the study period. At our institution patients with compound skull fractures are placed on antibiotic prophylaxis for 72 hours to prevent the development of wound sepsis. With regards compound skull fractures this prophylaxis comprises gram positive cover using intravenous cloxacillin 1g administered 6 hourly, gram negative cover using intravenous ceftriaxone 1g administered 12 hourly and anaerobic cover with intravenous metronidazole 400mg 8 hourly. If the patient is taken to the operating room this is changed to a first generation cephalosporin namely intravenous cephazolin 1g administered 8 hourly for 3 days. We rarely encounter a problem with this regimen however will readjust according to pus swab culture and susceptibility results if indicated. Patients with closed injuries only receive prophylaxic antibiotics if managed operatively and this comprises a first generation cephalosporin namely intravenous cephazolin 1g administered 8 hourly for 3 days.
With regards post-traumatic seizure prophylaxis all patients with depressed skull fractures, extradural or acute subdural hematomas, intracerebral hematomas or intracerebral contusions are loaded with intravenous phenytoin 15mg/kg in 200ml saline over 20-30 minutes (50mg/minute) to prevent early post-traumatic seizures. Post loading these patients are given intravenous phenytoin 100mg 8 hourly. This seizure prophylaxis is continued for 7 days and stopped if no seizures develop.
At our institution we are particularly aggressive when a dural breech is suspected and this is considered a Neurosurgical emergency. Clinically this is confirmed when cerebrospinal fluid or brain matter is oozing form the head wound, and radiologically this is suspected when pneumocephalus, indriven bone or a subdural abscess is present. These patient are urgently taken to the operating room for surgical exploration and dural repair.
The presence of a skull fracture is commonly associated with an extradural hematoma [2] which may or may not require management in its own right which we determine according to the 2007 Brain Trauma foundation guidelines [3]. Here a volume exceeding 35ml, a maximum thickness exceeding 15mm or midline shift of 5mm or greater are immediate surgical indications. If not meeting these criteria a patient is routinely re-scanned 6 hours later and a decision for operative or conservative management is made according to these same rules [3]. The presence of an acute subdural hematoma is managed according to a completely different set of guidelines as dictated by the 2007 Brain Trauma Foundation guidelines. Here an acute subdural hematoma of 10mm thickness or greater, or midline shift of 5mm or greater is managed surgically irrespective of the admission GCS. An acute subdural hematoma of less than 10mm thickness or midline shift of less than 5mm is managed surgically if there is a drop in GCS of 2 or more points from injury to presentation, the patient presents with lateralizing signs for example anisocoria, or the intracranial pressure is more than 20mmHg [3]. In acute subdural hematomas that are managed conservatively by not meeting the above guidelines we routinely repeat the CT brain 12 hours later and reassess the surgical indications according to the same set of rules.
In this study data captured included patient demographics, patient referral pattern, presence of alcohol intoxication at presentation, presence of wound sepsis at admission, post resusitation Glasgow Coma Scale, Computerized Tomography (CT) scan findings and GOS at discharge.
Results
A total of 41 patients with cranial injuries secondary to community mob assault were treated from January 2015-December 2016. All of the patients treated were male. The mean age was 30.5 +/- 9.1 years, the median age was 28 years, and the youngest patient was 17 years old and the oldest patient was 55 years old. Although not statistically significant (p=0.94) a trend was demonstrated where the highest proportion of the GOS 1 (deceased) group were 21-30 years old. In terms of referral 16 (39%) of patients were referred from local hospitals, 8 (19.5%) were referred from local clinics, and 17 (41%) were referred from the scene of the assault. A clinical trend was demonstrated whereby the highest percentage of GOS 1 (deceased) were referred from the scene of the assault and the highest percentage of GOS 5 were referred from local clinics. This was however not statistically significant (p=0.19). Looking at the socioeconomic status of subjects, 33 (81%) were unemployed and 8 (19%) were employed. There was no statistical significance demonstrated between socio-economic status and GOS (p=0.36).
Alcohol involvement was confirmed in 14 (34%) of subjects and excluded in 3 (7%) of subjects, however in 24 (58%) of subjects this was unknown. No statistical significance could be determined as in the majority of subjects alcohol status on admission was unknown (p=0.42).
Only 3 (7%) of subjects has isolated head injuries while 38 (93%) had additional injuries. A clinical trend was demonstrated where in the GOS 1 (deceased) group 100% of subjects had a cranial injury and additional injuries. This was however not statistically significant (p=0.63).
Severity of head injury analysis showed that 15 (41%) presented with mild head injuries, 20 (49%) presented with moderate head injuries, 5 (2.4%) presented with severe head injuries and 1 patient presented with a critical head injury. In GOS 5, 19 (100%) of subjects presented with mild/moderate head injuries while in GOS 1 (deceased) group 3 (50%) of subjects had severe/critical head injuries. Statistical significance was demonstrated between the severity of the post resusitation GCS used at a measure of the severity of the head injury and GOS (p=0.02).
Site of head trauma recorded showed that 11 (37%) of subjects had isolated parietal injuries, 9 (30%) had isolated frontal injuries, 4 (13%) had base of skull fractures and 5 (17%) had multiple sites of cranial injury. A trend was demonstrated in the GOS 1 (deceased) group where 3 (75%) of subjects had multiple sites of cranial trauma while in GOS 5 group 11 (68%) of subjects had either an isolated frontal or isolated parietal injury. No statistical significance was however demonstrated between site of cranial injury and patient outcome (p=0.12).
CT features showed that 9 (26.4%) of subjects had an acute subdural hematoma, 8 (24%) of subjects had an extradural hematoma, 7 (21%) had an intracerebral contusion and 4 (12%) had cerebral edema. A clinical trend was demonstrated where in the GOS 1 (deceased) group, while 4 (67%) of subjects had either an acute subdural hematoma or contusion, while in the GOS 5 group the highest percentage of subjects had an extradural hematoma. No statistical significance was however demonstrated between type of intracranial pathology and GOS (p=0.32).
At discharge 6 (14.5%) of subjects were GOS 1 (deceased), 10 (24%) were GOS 3, and 6 (15%) were GOS 4. Only 19 subjects (46%) were GOS 5 at discharge. The study reveals that secondary to Community mob assault 16 (39%) of subjects either demised or are so disabled they are dependent in their daily life due to physical or mental disability. Only 19 (46%) of subjects resumed normal life post community mob assault.
Discussion
Looking at patient demographics the study result that all 41 (100%) of the subjects who fell victim to community mob assault were male is a typical finding echoed in another South African study that considered cranial injuries secondary to machete injuries where 93% of subjects were male [4]. An Australian study that considered traumatic brain injury secondary to assault supports this were 97% of the subjects were male [5]. The study result that the mean age of subjects was 30.5 years is another typical finding seen in the above South African study [4]. This finding that a significant number of subjects are unemployed is supported by a study done in Wales where socioeconomic geographic clustering was evaluated in relation to the risk of suffering a traumatic brain injury secondary to assault [1]. In this study the highest clustering existed for residents of the poorest communities [1].
Considering alcohol intoxication at the time of presentation it must be noted that at our institution no actual blood alcohol measurement was done and hence the note of whether or not there appeared to be alcohol involvement is the subjective opinion of the attending Doctor. This is a study limitation regarding this finding as for example diabetic ketoacidosis can give a similar odour to a patient’s breath. The association between alcohol intoxication and the risk of suffering a traumatic brain injury secondary to assault is however clearly established in the literature as put forth in the above Australian study that specifically considered this variable and noted that in 73% of cases of traumatic brain injury secondary to assault the use of alcohol was confirmed [5]. Alcohol use increased an individual’s chance of being both the aggressor and victim [5].
Our study finding noting the significant role that the post resuscitation severity of head injury grading makes in prognosticating patients post traumatic brain injury finds extensive support in the literature [6;7]. Major studies such as the International Mission for Prognosis and Analysis of Clinical Trials in Traumatic Brain Injury (IMPACT study) which identified prognostic variables determining outcome in Traumatic Brain Injury identified severity of head Injury as a major determinant in outcome [7].
The study finding that Isolated frontal or parietal injuries resulted in the greatest chance of an individual having a favorable outcome is supported by the literature [8]. The frontal area of the brain is an area that can accommodate considerable mass lesions before neurological deterioration [8] as opposed to multiple area involvement as would for example accompany an acute subdural hematoma which due to the lack of anatomical barriers would expand within the subdural space to involve the frontal temporal and parietal areas simultaneously [8].
The study finding noting the prognostic significance of the type of abnormality seen on the CT scan whereby a poorest prognosis associated with an acute subdural hematoma and the most favourable prognosis associated with an extradural hematoma is supported extensively in the literature. Marshall’s landmark paper looked specifically at the odds ratio in terms of predicting outcome based of the presence of each of these lesions and found that while the presence of an acute subdural hematoma carries with it a mortality rate of 50%, the presence of an extradural hematoma carries with it a mortality rate of 18% [9]. The IMPACT study also found an acute subdural hematoma to carry with it an independent poor prognostic predictive value [7]. An acute extradural hematoma on the other hand carries with it a much more favorable predictive outcome [7].
In our study no patients had a Glasgow Outcome Score of 2 and this is explained by the fact that a GOS of 2 indicates a patient whom is in a persistent vegetative state. These patients need continuous specialized nursing care as they cannot provide for any of their needs. Our institution does not have a step-down facility and the patient’s family are often unable to care for the individual in the home environment. These patients hence remain in our ward where they are either optimized to a GOS of 3 and they can be discharged or they become part of the deceased group (GOS 1) secondary to complications such as drug resistant lower respiratory tract infections or systemic sepsis.
In conclusion our study aimed to evaluate the impact that community mob assault has on an individual who falls victim to this devastating mechanism of injury. The study revealed that secondary to Community mob assault 39% of subjects either demised or are so disabled they are dependent in their daily life due to physical or mental disability. Less than half (46%) of subjects resumed normal life post community mob assault.
Declaration
We the authors declare that this article has not been published previously, nor is it under consideration for publication elsewhere, and that, if accepted, will not be published elsewhere in the same form, in English or in any other language, without the written consent of the publisher
Conflict of interest
We the authors listed have no conflicts of interests with regards to material contained and disseminated in this article.
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.
