AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/2692-9406/023
*Corresponding Author: Mohammed Ahmed A. Ahmed and Kamal Omer Abdalla, Faculty of Medicine & Health Sciences, University of Gadarif, P. O. Box 449, 32211 Gadarif, Sudan.
Citation: M bashir, J O. Alagbe, A M Betty, Omokore E.A. (2020) Etiology and Clinical Features of Acute Flaccid Paralysis among Children in Gadarif, Sudan. Biomedical Research and Clinical Reviews. 1(4); DOI: 10.31579/2692-9406/023
Copyright: ©2020 Mohammed Ahmed A. Ahmed and Kamal Omer Abdalla, 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: 12 September 2020 | Accepted: 12 October 2020 | Published: 17 October 2020
Keywords: acute flaccid paralysis; features; etiology; sudan
Acute Flaccid Paralysis (AFP) is a rare but a serious neurological condition characterized by sudden weakness or paralysis of one or more extremities, the respiratory or bulbar muscles and reduced muscle tone without other obvious cause. Death occurs in about 7.5% of AFP affected patients worldwide. AFP is the most common sign of acute polio. Therefore, AFP studies are important for surveillance during polio outbreaks to differentiate polio cases from AFP cases. There is a lack of information about the clinical features & causative factors of AFP among children in Gadarif, Sudan. The identification of AFP cases and its causative factors are important in the management & prevention of the disease. This study assessed the etiology and the clinical features of AFP among children in Gadarif, Sudan aiming at effective management & prevention of the disease. It was a prospective cross sectional study conducted at Gadarif Pediatrics Teaching Hospital during the period of January 2017-December 2019. It comprised 73 children with confirmed AFP, ages 6 months to < 15 years old. Our study revealed that Poliomyelitis was not the cause of AFP. AFP was significantly affected children with youngest ages 0-5 years old and from the rural areas. Guillain-Barré syndrome (GBS) was the leading cause of AFP followed by meningitis, traumatic neuritis and hypokalemia and we believed that infections were the main triggers of GBS. Gender did not affect the prevalence of the AFP. Fever and paraplegia were the most prevalent clinical signs at onset of the weakness. Over 50% of the AFP victims showed symmetric paralysis. It is obviously that AFP-based awareness, provision of high-quality health services and fighting of illiteracy and poverty in the rural areas of Sudan are urgently needed for effective management of AFP.
Acute Flaccid Paralysis (AFP) is a neurological condition characterized by sudden weakness or paralysis of one or more extremities, the respiratory or bulbar muscles and reduced muscle tone without other obvious cause (Alberta Government Health and Wellness, 2005). AFP is often used to describe a sudden onset as might be found with polio. AFP is a rare disease but it is a serious condition. The disease can impair patient’s life and can be life-threatening if it affects the respiratory muscles (Kelly et al., 2006). Recovery from AFP if appropriate therapy is applied may take weeks to years, with about a third having some permanent weakness (Ferri, Fred F., 2016); NIAMS., 2016). Globally, death occurs in about 7.5% of AFP affected patients (NIAMS. 2016). AFP is the most common sign of acute polio. Therefore AFP studies are important for surveillance during polio outbreaks as it helps to eradicate poliomyelitis and to determine the real causes of AFP to prevent its occurrence.
AFP affects the nervous system, specifically the area of the spinal cord gray matter, which causes the muscle reflexes in the body to become weak. AFP is a heterogonous disorder that can be caused by several etiologies. AFP may be caused by disease or by trauma affecting the nerves associated with the involved muscles (Alberta et al., 2005). Clostridium botulinum bacteria that cause botulism can cause flaccid paralysis through producing a toxin that blocks the release of acetylcholine that results in blocking the exocytosis of presynaptic vesicles containing acetylcholine and that prevent the muscle contraction (Saladin, Kenneth S, 2012). If the C. botulinum affects the respiratory muscles, then it can lead to respiratory failure and ultimately death. By a similar mechanism of C. botulinum, a poison found in Curare a pant belongs to the species Chondrodendron tomentosum and various species of the genus Strychnos, native to South America can also cause AFP (Blueplanetbiomes.org; Saladin, Kenneth S, 2012). Other causes of AFP include poliomyelitis (polio), transverse myelitis, Guillain–Barré syndrome, enteroviral encephalopathy, traumatic neuritis and Reye's syndrome (Idris M et al., 2007; Kelly H et al., 2006). Many studies showed that AFP was caused by oral polio vaccinations (www.cdc.gov 2001; Suzanne Humphries and Roman Bystrianyk. 2013; Vashisht et al., 2015). Some venomous snakes and chemical warfarenerve agents such as VX can also cause complete flaccid paralysis (GJ Müller et al., 2012; Sidell, Frederick R. 1997).
The clinical diagnosis of AFP has geographical variations, due to environmental and genetic factors differences (Saraswathy TS., et al., 2008). In Australia 63–72% of AFP cases were attributed to either Guillain-Barré´ syndrome or transverse myelitis (D’Souza et al., 1999). Morris et al., 2003 reported acute disseminated encephalomyelitis, tick-bite paralysis and infant botulism as some causes of AFP in children in Australia. In Malaysia, Guillain-Barré syndrome, central nervous system infections and transverse myelitis were the main causes of AFP (Hussain et al., 1999). While in South West Nigeria, traumatic sciatic nerve palsy, acute polyneuritis, neuropathy and anterior poliomyelitis were the main causes of AFP among children in that country (Fawole, 2003).
From the reviewed literatures mentioned previously, Guillain–Barré syndrome (GBS) was the common main cause of AFP globally wise. GBS is a rapid-onset muscle weakness caused by autoimmune disorders resulted in the immune system damaging the peripheral nervous system (NIAMS, 2016). GBS often affects the arms and upper body. During the acute phase, GBS can be life-threatening, with about 15% of people developing weakness of the breathing muscles (Ferri, Fred F., 2016). Some are affected by changes in the function of the autonomic nervous system, which can lead to dangerous abnormalities in heart rate and blood pressure (NIAMS, 2016). Sometimes the immune dysfunction in GBS is triggered by an infection or, less commonly by surgery and rarely by vaccination. Guillain–Barré syndrome is rare, at one or two cases per 100.000 people every year (Sejvar, James J. et al., 2011). Both sexes and all parts of the world have similar rates of the disease (Ferri, Fred F. 2016). GBS has also been reported in association with COVID-19, and may be a potential neurological complication (Zhao H., et al 2020; Carod-Artal FJ., 2020). There are a number of subtypes based on the areas of weakness, results of nerve conduction studies and the presence of certain antibodies. It is classified as an acute polyneuropathy (Ferri, Fred F., 2016).
In 2002 AFP’s rate in Sudan was found 2.6% (WHO, 2004). AFP is a costly disease as it can cause death with high mortality rate or cause permanent impairment of patient’s life (NIAMS. 2016). There is lack of information available about the clinical features & causative factors of AFP among children in Gadarif in particular and Sudan in general. The identification of AFP cases and its causative factors are important in the management of the disease and its prevention. Ideal treatment and prevention of AFP is based on determination of the etiologic factors. Moreover, regular surveillance and monitoring of common causes of AFP and its regional variations are important to provide physician’s knowledge on the updated and most effective empirical treatment of AFP. The aim of this study was to assess the etiology and the clinical features of Acute Flaccid Paralysis (AFP) among children in Gadarif, Eastern Sudan aiming at better management of AFP and its complications. In this respect this study is important.
This study was a descriptive cross sectional hospital based study that was conducted at Gadarif Pediatrics Teaching Hospital in Eastern Sudan during the period from January 2017 to December 2019. The study comprised 73 children with ages ranging from 6 months to less than 15 years old with confirmed diagnosis of AFP disease. The study aimed to evaluate the etiology and clinical features of AFP in Gadarif aiming at effective management & prevention of the disease. Informed consents were taken from the parents or guardians of the patients. The study was approved by the Health Research and Ethical Committee of the Ministry of Health of Gadarif State.
Inclusion Criteria:
Children from 0 months to less than 15 years old with acute flaccid paralysis in one or more limbs without signs of upper motor neuron lesion were included.
Exclusion Criteria:
Children with signs of upper motor lesion were excluded from the study.
Statistical Analysis
Data was entered into a computer database and SPSS software (SPSS Inc., Chicago, IL, USA, version 21.0) and double checked before analysis. Analysis of variance was used to compare means and x2 was used for categorical variables. Uni-variable and multivariable logistic regression were used to identify factors associated with complications. For associated factors, odds ratios (OR) were determined with 95% confidence intervals [95% CI].
Results:
A total of 73 cases of AFP were diagnosed in children less than 15 years old during the 3-year period of the study, of these cases 38 (52.1%) were male and 35 (47.9%) were female (figure1) gave male to female ratio of 1.1:1. The age ranged between 6 months to 15 year with mean 4.1, the majority of patients were seen in 0-5 year’s age group 53 (72.6%) of the AFP cases. The age distribution is shown in (figure2). 65(89%) of cases were of rural residence (figure 3). 40 (54.8%) cases showed symmetrical paralysis of muscles (table1), neck muscles weakness was observed in 2 (2.7%) cases. Paraplegia was high 32 (43.8%) and 47 (64.4%) of cases had fever at onset of weakness. Guillain-Barre Syndrome (GBS) was the main cause of AFP 25(34.2%) of patients, followed by Meningitis (Figure 3).
Our study showed that in Gadarif, the frequency of AFP cases was little bit higher among male children 52.1% compared to female children; this difference was not statistically significant (p>0.000). Similar findings to ours were reported in studies conducted in Malaysia, Turkey and Nepal (Saraswathy TS., et al., 2008; Sevencan F., et al., 2013 & Sharma K S., et al., 2011). This fact indicates that gender does not significantly affect the incidence rate of AFP. Our study also revealed that AFP prevalence was higher in children with youngest ages of 0-5 years old as 72.6% of the AFP cases were found within this age range. Similar data to ours were published by Memon et al., 2010 and Sevencan et al., 2013. The fact that AFP is more prevalent among children with smaller ages is believed to be due to their relatively high susceptibility to infections in this age group and the increased susceptibility to the young myelinated peripheral nerves to demyelination (Koulet al, 2010; Rantalaet al, 1994). Generally, children are among human groups who need special care. Children have not well developed immune system, have low nutrient reserves & high metabolic needs; these make children exceptionally more vulnerable to wide arrays of diseases and even slight nutritional deprivation. Children require nutrients and energy to support their growth and development (Kamal Abdalla, 2020). Our study also revealed that rural residents 65(89%) were more susceptible to AFP disease compared to the urban residents 8 (11%), (P < 0.000). This might attributed to high poverty and illiteracy among the rural residents of Sudan compared to urban citizens.
The clinical characteristics showed by this study were fever at onset of the AFP, the lower limbs affected more significantly compared to the upper ones, symmetrically increased in the distal limbs. In this study, more than half of the studied children 87.7% had got completed vaccines against polio. Partial vaccination and non-vaccination of children in Sudan more spread among children of the rural areas due to ignorance of the parents about the importance of vaccination and difficulties to reach city hospitals and health centers where vaccines are normally available. In rural areas of Sudan, still there are big sectors of pregnant women who give delivery by traditional methods far from medicine due to lack or appropriate health facilities.
This study revealed that Guillain-Barre Syndrome was the main cause of AFP among children in Gadarif 34.2%, followed by Meningitis 17.8%. These findings were in agreement with international reviewed literatures published on GBS as mentioned previously in the introduction of this study. GBS is the most common cause of AFP worldwide (Momen and Shakurnia, 2016). This calls for international cooperative efforts to manage the GBS especially to eliminate its causative factors. Sometimes the immune dysfunction in GBS is triggered by an infection or, less commonly by surgery and rarely by vaccination. GBS has also been reported in association with COVID-19, and may be a potential neurological complication (Zhao H., et al 2020; Carod-Artal FJ., 2020). In Sudan, a country with high illiteracy ratios, poverty and poor health knowledge especially among the rural residents of the country, we believe that infections are the major triggering cause of GBS and consequently AFP prevalence among children in Gadarif. Prevention of infections and proper treatment of it during early ages of children between 0-5 years old particularly in rural areas will contribute well in the prevention of AFP. Traumatic neuritis & hypokalaemic paralysis contributed to third & fourth causative factors respectively of AFP among children in Gadarif. These findings were agreement in a report published by Sharma et al., 2011. Also, this calls for joint international efforts to manage traumatic neuritis & hypokalaemic paralysis towards eradication of AFP.
In conclusion, this study revealed that Poliomyelitis was not the cause of AFP. AFP was significantly affected children with youngest ages 0-5 years old and from the rural areas. Guillain-Barré syndrome (GBS) was the leading cause of AFP followed by meningitis, traumatic neuritis and hypokalemia and we believed that infections were the main triggers of GBS. Gender did not affect the prevalence of the AFP. Fever and paraplegia were the most prevalent clinical signs at onset of weakness. Over 50% of the AFP victims showed symmetric paralysis. It is obviously that AFP-based awareness, provision of high-quality health services and fighting of illiteracy and poverty in the rural areas of Sudan are urgently needed for effective management of AFP.
Acknowledgements
The authors sincerely thank the parents and the guardians who consented to participate their children in the study. We also sincerely thank AFP surveillance team for assisting in accomplishing this study.
Conflict of interests
None
Funding
None.
Authors’ Contributions
All authors contributed substantially to the study conception and design, data collection and analysis, and drafting and revision of the article. All authors approved the final version to be published.
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.
