AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/2768-2757/085
1 Emergency Department, UKRIDA Hospital, Jakarta, Indonesia, 11510.
2 Department of Internal Medicine, UKRIDA Hospital, Jakarta, Indonesia, 11510.
3 Department of Surgery, UKRIDA Hospital, Jakarta, Indonesia, 11510.
*Corresponding Author: Geresu Gebeyehu, Addis Ababa University, Addis Ababa, Ethiopia.
Citation: Geresu Gebeyehu, Gutu Leta, Selamawit shiferaw, (2023), Magnitude and Associated Factors of Intraoperative Hyperglycemia among Orthopedics Surgical Patients. A Cross-Sectional Study, Journal of Clinical Surgery and Research, 4(4); DOI:10.31579/2768-2757/085
Copyright: 2023, Geresu Gebeyehu. 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: 16 June 2023 | Accepted: 24 June 2023 | Published: 04 July 2023
Keywords: magnitude; intraoperative hyperglycemia; orthopedic surgery; associated factors
Background: Intraoperative hyperglycemia is a common problem among patients undergoing orthopedic surgery. Its incidence varies from country to country and not clearly studied in developing countries.
Method: Multi-center cross-sectional study was conducted on eligible adult elective patients who underwent orthopedic surgical procedures. The participants were selected using a systematic random sampling technique. Data was collected on basic characteristics, medical and surgical history. On the arrival of patients to the OR, blood glucose was measured and recorded and repeated after administering anesthesia. The data was analyzed using descriptive statistics and bivariate and multivariate logistic regression. P<0.05 was considered as statistically significant.
Results: Intraoperative hyperglycemia was observed in 20.4% of patients. Hypothermia (AOR:2.45;95% CI:0.97-6.27, p=0.05), infused dextrose iv fluids (AOR:2.94;95% CI:1.64-5.16, p=0.05), blood transfusion (AOR:6.64;95% CI:2.92-15.08, p=0.00) and history of hypertension (AOR:2.19;95% CI:1.23-3.71, p=0.01) were factors identified to be associated with intraoperative hyperglycemia.
Conclusions: This study showed the magnitude of intraoperative hyperglycemia was high. Anesthetists should identify all risk factors preoperatively and make appropriate adjustments for patient care. Hypertension should be optimized, refrain from routine administering of dextrose IV fluids, and unnecessary transfusions, as well as monitor patients’ body temperature.
The number of orthopedic surgical approaches is growing in older individual in whom the magnitude of diabetic disease is dramatically alarming currently [1]. Acute hyperglycemia, which occurs after traumatic injury, has also obtained a lot of attention; because trauma induces the release of stress hormone, mostly mediated by glucagon, leading to an increase in oxidative stress and insulin resistance, finally hyperglycemia occurs [2].
It was well known that poor perioperative glycemic management were associated with negative outcomes encompassing impaired wound healing, hardware or implant failure, extended threat of surgical site infections, and pseudarthrosis for the duration of orthopedic surgical procedures [3].
The American Diabetes Association estimates that 12–25% of hospitalized personnel have diabetes mellitus (DM). With the growing occurrence of diabetic suffererspresentingfor surgical process and the elevated threat of headaches related to diabetes mellitus, suitable perioperative evaluation and control are imperative [4].
It wasreported that 10 to 20% of orthopedic surgery patients were diagnosed with diabetes. Corsino and colleagues in their study reported that 22 to 46% of non-critically ill patients faced hyperglycemia with or without a history of diabetes and Umpierrez et al. also estimated hyperglycemia in 32 to 38% of hospitalized individuals in community health facilities [5, 6].
Kwon et al reported that non-diabetic patients who encountered perioperative hyperglycemia had nearly twice the risk of infection, reoperative intervention, and in-hospital death when compared with known diabetic patients [7]. Another study conducted by Meltem T. et al. reported that in-hospital hyperglycemia is an important clinical indicator, carrying a higher 1- and 5-year mortality risk than those who have previous history of diabetes [8].
It was reported in the past that transient hyperglycemia among patients in critical condition is without adverse outcome, even imagining that it is beneficial; but several studies showed that there is clear mortality and morbidity advantages from strict glycemic control of glucose level with insulin therapy in critically sick ICU individuals without considering diabetic or non-diabetic status of the patients [9].
Reports came out by Gerard M. et al speculating that the health professionals’ attitude to screen out, monitor, and follow perioperative blood glucose, and start therapy for hyperglycemia is not much enough and neglected unless subject has history of diabetes mellitus [10].
Even though, the number of individuals requiring advanced technologies and procedures are increasing in orthopedics unit [11] but, evidence regarding magnitude and associated factors of intraoperative hyperglycemia for adult patients who underwent orthopedic surgery does not exist in developing nations including our country Ethiopia. This study was aimed at determining the magnitude and associated factors of hyperglycemia in elective non-diabetic adult orthopedic patients in public tertiary hospitals in Ethiopia.
1.1 conceptual framework
The conceptual framework prepared based on the literatures reviewed for the evidences in this study. (Figure. 1)
Figure 1: Conceptual framework indicating factors affecting intraoperative hyperglycemia for adult patients undergoing elective orthopedic surgical procedures at tertiary hospitals, Addis Ababa, Ethiopia2022.
2.1 Study design and setting, period, and population
A multicenter cross-sectional study was conducted at selected public hospitals in Addis Ababa from January 01 to April 01, 2022. The source population was all adult orthopedic surgical patients admitted to public hospitals in Addis Ababa. The study population was all eligible adult orthopedic surgical patients during the study period. All ASA I and II, and aged above 18 years old were included into this study. Patients with a history of diabetes mellitus, confirmed pregnancy and taking steroid therapy were excluded.
2.2 Sample size determination
The sample size was determined using the single population proportion for the first objective, which is the magnitude of intraoperative hyperglycemia in non-diabetic adult patients who underwent elective orthopedic surgical procedures. Since there was no related study conducted in the study area, we used P = 0.5 for calculation to get the maximum sample size, 95% level of significance, 5% margin of error, and 10% for incomplete or as contingency data will be used as parameters.
n = 384
By using correction, the formula for finite population, since source populations were less than 10,000
nf = n/ (1 + n/N), N = 506…. Correction formula for population less than 10,000.
Nf = n/1 + n/N = 384/ (1 + 384/506) = 218. By Adding 10% contingency for non-response rate(i.e., 218 + 22 = 240). As a result, a total of 240 adult major elective orthopedic surgery patients were included in this study.
Nf = Final sample size,
n = sample size,
N = total number of adult patients who underwent elective orthopedic surgery
2.3 Sampling techniques and procedures
Systematic random sampling technique was used. The study settings have been selected randomly from Addis Ababa governmental city hospitals. We included every second adult patient underwent elective orthopedics surgery during the study period. Patients’ capillary blood glucose was measured immediately after the patient arrived the operation theater and then continued from induction of anesthesia and every hour up to the end of the surgery.
2.4 Operational Definitions
Preoperative
The time that extends from the decision to have surgery to induction of anesthesia [12].
Intraoperative
The period that extends from induction of anesthesia until the patient is transported to PACU [13].
Perioperative
the period comprises all three periods (preoperative, intraoperative and postoperative) [6].
Hypothermia
Core body temperature below 36 degrees Celsius [14].
MINS (Myocardial injury in non-diabetic surgery): Factors unique to hyperglycemia conditions that increase atherosclerotic plaque formation and thrombosis, thereby contributing to myocardial infarction [15].
SIH (Stress induced hyperglycemia): Stress hyperglycemia or hospital-related hyperglycemia as any blood glucose concentration > 7.8 mmol/l (140 mg/dl) without evidence of previous diabetes [16].
2.5 Data collection tool and procedures
Data was gatheredusingpretested questionnaires. Training was provided for all data collectors on data collection procedures in each of the study settings. The data collection tool included socio-demographic, medical history and intraoperative clinicalconditions and anesthetic agents. Sociodemographic and medical history were obtained from the patients charts on the immediate arrival of patients into the OR, and regarding intraoperative blood glucose, and anesthetic and surgical dataduring the intraoperative period were recorded from anesthesia charts during anesthetic induction and every one-hour interval until surgery ends.
2.6 Data quality control
To assure the quality of data, training on the objectives and relevance of the study and brief orientations on the assessment tools were provided for data collectors. The questionnaires were pretested on 5% of the study population at ALERT hospital.
2.7 Data processing and analysis
The collected data was coded, cleaned, retrieved, and entered in to SPSS for analysis. Descriptive statistics were used to analyze sociodemographic characteristics. Bivariate and multivariable regression analysis were performed to assess the association between dependent and independent variables.Odds ratios with 95% CI were used to determine the degree of association between dependent and independent variables. In multivariable regression analysis, variables with a p-valueof < 0.05 were considered as statistically significant. The results were presented using words, tables, and figures.
3.1 Socio-demographic characteristics of study participants
240 elective major orthopedic adult patients were included in the study with a 100% response rate. (Table 1)
| Variables | Category | Frequency | Percentage (%) | |
|---|---|---|---|---|
| Gender | Male | 196 | 81.7 | |
| Female | 44 | 18.3 | ||
| Age | 18–40 | 178 | 74.2 | |
| 41–60 | 51 | 21.3 | ||
| > 60 | 11 | 4.6 | ||
| ASA status | ASA I | 190 | 79.2 | |
| ASA II | 39 | 16.3 | ||
| ASA III | 11 | 4.6 | ||
| BMI | < 18.5 | 30 | 12.3 | |
| 18.5–24.9 | 193 | 80.4 | ||
| 25-29.9 | 12 | 5.0 | ||
| > 30 | 5 | 2.1 | ||
| Co-existing diseases | History of Hypertension | Yes | 21 | 8.8 |
| No | 219 | 92.2 | ||
| History of Anemia | Yes | 56 | 23.3 | |
| No | 184 | 76.7 | ||
| History of sepsis | Yes | 36 | 15.0 | |
| No | 204 | 85.0 | ||
Table 1: Socio-demographic and preoperative clinical characteristics of elective orthopedics surgery patients at tertiary public hospitals, Addis Ababa, Ethiopia 2022
3.2 Anesthetic and surgical characteristics of patients
Intraoperative anesthetic and surgical characteristics were analyzed and the findings were presented below. (Table 2)
| Variables | Category | Frequency | Percentage (%) |
|---|---|---|---|
| Anesthesia type | General | 32 | 13.3 |
| Spinal | 183 | 76.3 | |
| Combined | 15 | 10.4 | |
| Surgery time | ≤ 60min | 38 | 15.9 |
| > 60 min | 202 | 84.1 | |
| Tourniquet used | Yes | 24 | 10.0 |
| No | 216 | 90.0 | |
| Steroids used | Yes | 41 | 17.1 |
| No | 11 | 4.6 | |
| Vasopressors used | Yes | 29 | 12.1 |
| No | 13 | 5.4 | |
| Dextrose IV fluids | Yes | 29 | 12.1 |
| No | 211 | 87.9 | |
| Blood transfusion | Yes | 31 | 12.9 |
| No | 209 | 87.1 | |
| Blood loss | ≤ 300ml | 138 | 57.5 |
| > 300ml | 102 | 42.5 | |
| Hypothermia | Yes | 22 | 9.2 |
| No | 218 | 90.8 |
Table 2: Anesthetic and surgical characteristics of elective orthopedics surgery patients at tertiary public hospitals, Addis Ababa, Ethiopia2022
3.3 Magnitude of Intraoperative hyperglycemia in patients undergoing orthopedics surgery
Intra-operative hyperglycemia report was displayed below. (Figure. 2)
Figure 2: the magnitude of intraoperative hyperglycemia in orthopedic surgical patients at public hospitals, Addis Ababa, Ethiopia, 2022.
3.4 Factors associated with Intraoperative hyperglycemia
Both bivariate and multivariate analysis were conducted to determine the association between the outcome variable and the independent variables and the strength of associations and the findings displayed in Table 3.
| Variables | categories | Intraoperative Hyperglycemia | COR,95%CI | AOR,95%CI | P-value | |
| Yes | No | |||||
| Gender | Male | 34 | 162 | 0.40;0.23–0.89 | 0.42;0.20-.84 | 0.54 |
| Female | 15 | 29 | I | |||
| Age | 18–40 | 32 | 146 | I | ||
| 41–60 | 16 | 35 | 4.57;0.54–38.18 | 0.48;0.0.24–0.97 | 0.16 | |
| > 60 | 1 | 10 | 0.21;0.03–1.86 | 0.16;0.15-0,17 | 0.17 | |
| ASA status | ASAI | 34 | 163 | 0.10;0.06–0.19 | 0.58;0.15–2.30 | 0.32 |
| ASAII | 12 | 20 | 0.34;0.15–0.78 | 0.49;0.23–1.08 | 0.1 | |
| ASAIII | 3 | 8 | I | |||
| No | 34 | 164 | I | |||
| Anesthesia type | General | 7 | 25 | 3.25;0.25–18.77 | 0.97;0.35–2.69 | 0.188 |
| Spinal | 34 | 149 | 3.68;0.75–18.07 | 1.32;0.67–4.5 | 0.19 | |
| combined | 8 | 17 | I | |||
| History of hypertension | Yes | 12 | 19 | 2.94;1.3–6.60 | 2.19;1.23–3.71 | 0.01** |
| No | 37 | 172 | I | |||
| Preoperative sepsis | Yes | 14 | 22 | 0.19;0.16–0.64 | 2.27;1.36–3.77 | 0.18 |
| No | 35 | 169 | I | |||
| Duration of surgery | ≤ 60 min | 13 | 29 | I | ||
| > 60 min | 36 | 162 | 1.5;0.73–3.09 | 1.70;099-2.92 | 0.28 | |
| Tourniquet used | Yes | 5 | 19 | 2.12;1.23–4.12 | 1.02;.45-2.33 | 0.12 |
| No | 44 | 172 | I | |||
| Dextrose infusion | Yes | 7 | 6 | 5.14;1.64–18.08 | 2.94;1.64–5.16 | 0.05** |
| No | 42 | 185 | I | |||
| Intraoperative hypothermia | Yes | 8 | 14 | 2.47;0.01–0.25 | 2.45;0.97–6.27 | 0.05** |
| No | 41 | 177 | I | |||
| Blood transfusion | Yes | 16 | 13 | 0.32;0.20–0.42 | 6.64;2.92–15.08 | 0.00** |
| No | 33 | 178 | I | |||
| ** = statistically significant, COR = crude odds ratio, CI = confidence interval, AOR = adjusted odds ratio, I = reference | ||||||
Table 3: Associated factors of intraoperative hyperglycemia of elective orthopedics surgery patients at tertiary public hospitals, Addis Ababa, Ethiopia2022
Hyperglycemia is a common response to intraoperative stress of surgery and critical illnesses, and associated with poor outcomes in critically ill patients regardless of their diabetic status. It has been studied that the degree of rise of blood sugar levels due to surgical stress in controlled diabetics is less significant as compared to non-diabetics [17].
In our study, 20.4% of the study participants that underwent elective orthopedic surgery became hyperglycemic intraoperatively. This result is higher than that of a retrospective cohort study done by Mark P. et al.to evaluate the association between SIH and incident diabetes in survivors of critical illness [18]. Another cross‑sectional observational study done on 536 non-diabetic patients presented to the Intensive Care Unit (ICU) at Gandhi Medical College and allied Hamidia Hospital, Bhopal, between March, 2015, and May, 2015 identified 20.33%of participants developed stress hyperglycemia [19]. The result of our study was supported by the findings of the above study.
However, the finding of our study was smaller than the result of the observational study reported by Cornelia K. et al. where they reported 52.9% of intraoperative hyperglycemia out of 87 participants aged 65 years old and above [20]. This may be due to their inclusion of only geriatric patients in their study subjects.
An observational prospective study conducted at New Jersey Medical School, University of Medicine and Dentistry of New Jersey, USA, on 295 patients aged 18–80 years undergoing elective non-cardiac surgery reported the findings higher (49%) than the finding of this study [21]. The reason for this difference might be their inclusion of all non -cardiac surgery and hyperglycemia definitions they used (> 126 mg/dl).
Furthermore, the magnitude in this study was lower than the findings of a prospective observational study conducted on 191 patients who underwent primary hip and knee replacement, in which 40% of subjects developed hyperglycemia and 48 of them 25% of developed severe hyperglycemia [22]. The possible cause of these variations might be due to the exclusion of known diabetic patients from our study participants.
Patients with a history of hypertension were 2.19 times more likely to develop intraoperative hyperglycemia than normotensive individuals. This finding was in line with the Canadian Journal of Cardiology 2018 which stated that patients with hypertension often exhibit insulin resistance and are at greater risk of diabetes developing than are normotensive individuals [23]. Exaggerated catecholamine responseand consequent insulin resistance could be the probable reason for this.
In this study, patients who took intraoperative IV infusion of dextrose fluids were 2.94 times more likely to be hyperglycemic. This was supported by the findings of the study conducted by SaringCarinkul and Kotrawera in 2009, which found a progressive increase in blood glucose levels in patients receiving 5
This study found the magnitude of intraoperative hyperglycemia was high. History of hypertension (AOR: 2.19, 95% CI: 1.23–3.71), Intraoperative hypothermia (AOR: 2.45; 95% CI: 0.97–6.27), intraoperative dextrose fluid infusion (AOR = 2.94; 95% CI; 1.64–5.16), Intraoperative blood transfusion (AOR: 6.64, 95% CI: 2.92–15.08) (p = 0.00) were factors identified factors with significant association. The anesthetists and perioperative team should give attention to the identified factors and take necessary remedies to respective factors.
This manuscript was prepared from the academic research conducted at Addis Ababa University and deposited in the repository by Gutu Leta and Geresu Gebeyehu in 2022 [26].
Abbreviations
AaBET- Addis Ababa Burn, Emergency and Trauma
ASA- American Society of Anesthesiologists
AMI- Acute Myocardial Infarction
CBG- Capillary Blood Glucose
FMOH- Federal Ministry of Healthy
SIH- stress-induced hyperglycemia
Ethics approval and consent
Ethical clearance was received from Addis Ababa University IRB and Addis Ababa City Administration Health Bureau as well as informed verbal consent was secured from the study participants. Confidentiality was assured throughout the study.
Funding information: Financial support for this study was obtained from Addis Ababa University
Authors' contributions
All authors took part in an inception, design, analysis, interpretation, and drafting of the thesis manuscript. Moreover, all authors read and approved the revised manuscript for publication.
Availability of data and materials
The data will be available from the corresponding author up on reasonable request.
Competing interest: The authors state that there is no competing interest in this work.
Acknowledgments
The authors would like to thank Addis Ababa University for giving an ethical clearance and the study participants for participation. We also thank the study hospitals for accepting to conduct the study. Our special gratitude also goes to the study subjects for accepting and taking consent to conduct 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.
