AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/2641-0419/279
1Assistant Professor Department of Audiology and Speech Language Pathology, AWH Special College, Calicut – 673003 Kerala University of Health sciences.
2 Department of Audiology and Speech Language Pathology, AWH Special College, Calicut-673003 Kerala University of Health sciences
*Corresponding Author: Nayana Narayanan, AWH Special College Kallai Calicut Kerala – 673003.
Citation: Nayana Narayanan, Abhisha S. B Baslp. (2022). Relationship Between COVID-19 Virus, RAS System and Dysarthria: A Single Case Report. J. Clinical Cardiology and Cardiovascular Interventions, 5(9); DOI:10.31579/2641-0419/279
Copyright: © 2022 Nayana Narayanan, 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: 14 September 2022 | Accepted: 30 September 2022 | Published: 10 October 2022
Keywords: electroglottography; covid-19
The seventh human coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was detected in Wuhan, China, during a recent pneumonia outbreak in January 2020. The virus has since spread all across the world. Fever, fatigue, and respiratory problems, which can progress to pneumonia, are some of the symptoms. Symptoms usually emerge between 2 and 14 days.
The seventh human coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was detected in Wuhan, China, during a recent pneumonia outbreak in January 2020. The virus has since spread all across the world. Fever, fatigue, and respiratory problems, which can progress to pneumonia, are some of the symptoms. Symptoms usually emerge between 2 and 14 days.
Since being exposed to said virus, patients develop new, persistent or recurrent chronic health problems known as post-COVID diseases. Even Patients who did not suffer COVID-19 symptoms in the days or weeks following their infection may also develop post-covid issues. These conditions, also known as Long Covid, long-haul covid, post-acute COVID-19, might manifest themselves as various combinations of health issues throughout days or weeks. Long term complications of these conditions include issues of cardiovascular system, respiratory system, neurologic system, psychiatric conditions etc.
Dysarthria is one of the reported post COVID condition. ASHA refers to Dysarthria as “ a group of neurogenic speech disorders characterized by "abnormalities in the strength, speed, range, steadiness, tone, or accuracy of movements required for breathing, phonatory, resonatory, articulatory, or prosodic aspects of speech production" (Duffy, 2013).These abnormalities are due to one or more sensorimotor problems—including weakness or paralysis, incoordination, involuntary movements, or excessive, reduced, or variable muscle tone (Duffy, 2013).
Typically dysarthria is caused due to any pathophysiological altercations in the nervous system like cerebrovascular incidents, neural infection, and degenerative conditions etc. Dysarthria following COVID-19 infection is predominantly caused either due to stroke (Mahboob et.al,2020; Bhagat et.al, 2020; Beyrouti et.al,2020) or due to infections of nervous systems like meningitis and encephalitis (Mukherji et.al, 2021; Huo et.al, 2021; Katal, Balakrishnan, & Gholamrezanezhad, 2021). However, very rarely COVID-19 virus by itself directly damages the speech musculature thus causing dysarthria. Even though some authors have reported skeletal muscle pain and weakness in cases post COVID-19 (Ali, & Kunugi, 2021; Silva et.al, 2021), it is seldom reflected in the speech and language functions. In this report, we present such a case that did not have marked motoric weakness but had significant dysarthric component post COVID.
A 52-year-old male with a history of COVID-19 came to our department after 8 months of post-infection. The client reported progressive slurring of speech, left-sided tongue deviations, and swallowing difficulty following COVID-19 infection. The client underwent objective as well as subjective evaluation for all the speech and language parameters.
Screening MRI of brain was done followed by nerve conduction study. The client underwent detailed subjective evaluation of all the speech subsystem during which each speech subsystems namely; respiratory, phonatory, articulatory, resonatory and prosodic, were assessed using various task. Respiratory subsystem was assessed by observing the client’s breathing at rest as well as during speech. To assess the patient's respiration, he was instructed to take a deep breath in via the mouth and let it out slowly. The patient was instructed to count to 20 as rapidly as possible on one breath to assess respiration in speech. During this the client’s breathing pattern, effort, capacity etc during expiration and inspiration was recorded. Phonatory subsystem was assessed by asking the client to produce /a/, /i/, /u/ sound at length as well as during conversation with the client. The duration to which the client can prolong the vowel is jotted together with the pitch, loudness and quality of client’s voice. Pitch and loudness scaling was carried out to assess pitch and loudness range. The first task for assessing articulatory subsystem included conversing with the client while the second task included picture/topic description. During the course of these tasks, the errors in production of various consonant and vowel sounds are recorded with comment on overall intelligibility of speech. Resonatory system was assessed by asking the client to produce /mae/ and /pae/ alternatively. The perceptible difference between both the sounds was scrutinized. Also, the nasality during phonation of /a/ was noted. Prosodic system assessment included the reading of contrastive stress words and informal assessment of rhythm and intonation during various conversation instances (questions, narratives, statements etc)
Objective evaluation conducted included Dr. Speech (Tiger DRS, Inc) for phonatory-respiratory system, Electroglottography (Tiger DRS, Inc) for phonatory system. Fundamental frequency, jitter, shimmer, amplitude tremor, of the sounds /a/, /e/ and /u/ were recorded using Dr Speech software. Frenchay Dysarthria Assessment (Enderby & Palmer, 2008) was administered for rating the overall severity of dysarthria.
Dysphagia evaluation was carried out subjectively. The client was asked whether he cough or choke while eating. He was also asked whether he had difficulty in clearing throat following which the client was observed while drinking ½ cup of cold water and then while eating a cookie. The client was questioned whether he had any difficulties swallowing, eating quickly, or having limits on the sorts of things he could consume.
Oromotor examination was carried out subjectively to chart the weakness at the level of articulators. Structural abnormality of lips at rest was observed. The patient was asked to give an exaggerated smile to check lip spreading. Lip seal was assessed by blowing air into cheeks and by maintain for 15seconds. And then the patient was asked to say /P/……/P/ crisply and clearly for 10 times. Lips articulatory movements were tested by repeating “oo ee” for 10 segments in 10 seconds. The movements of lips in conversation were observed. Palatal maintenance was assessed by asking the patient to say-“ah-ah-ah” for. Tongue at rest was assessed by asking the patient to open his mouth. Tongue functions like protrusion, elevation, lateral movements were assessed. Alternate movements of tongue were assessed by asking the patient to say “ka la” for 10 times as quickly as possible. Intelligibility of words was also assessed.
Table 1 reveals the objective evaluation done and their respective results. The client’s imaging reports reveal Mild diffuse neuroparenchymal atrophy.
Nerve conduction study report shows, Axonal motor neuropathy involving bilateral peroneal nerves. Electroglottography results show normal glottal wave morphology with all the quotients within normal limits, however, voice evaluation through Dr Speech reveals hoarse voice with predominantly breathy voice quality. Results of the standardized test, Frenchay Dysarthria Assessment (Enderby & Palmer,2008), used to evaluate severity of dysarthria reveals mild dysarthria.
Table 1
The results of Dr. Speech and EGG are depicted in table 2 and table 3 respectively. Correspondingly, the voice quality and glottal wave pattern obtained from each is represented as figure 1 and 2. The Dr. Speech values depicts the client to be having moderate hoarse voice as EGG results reveal the glottal wave to be mildly affected with normal quotients.
Table 2: Voice Data
Note: This table depicts the acoustic analysis of voice of client. The acoustic correlates of pitch, intensity and quality is analyzed through the instrument Dr Speech. The values depict the results of the analysis. The parameters analyzed include F0: Fundamental Frequency, Jitter: cycle to cycle variation in frequency, Shimmer: cycle to cycle variation in intensity, SD: standard deviation, NNE: Normalized noise energy, HNR: Harmonic to Noise ratio, SNR: Signal to Noise energy, Amp: Amplitude.
* Values are not within normal limits
Table 3: EGG Evaluation Data
Note: The table shows the results of electroglottography (EGG) done on the patient. EGG represents the glottal wave during phonation of vowels. The parameters analyzed using EGG include CQ: Contact quotient, CI: Contact Index, OR: Open ratio, CR; Close ratio, CQP: Contact quotient percentage, CIP: Contact index percentage
All the parameters are within normal limits.
OPME evaluation; all articulators were structurally and functionally normal except for tongue and lips. Lips are structurally normal but the rate of motion is reduced. Tongue is Symmetrical at rest, and atrophy is present at center portion. Fasciculation / fibrillations is also evident with mild limitation in range and rate of motion.
Detailed evaluation of all the speech subsystem is shown in Table 4. As shown in the Table 4, Results of subjective evaluation of all subsystems of speech with swallowing assessment convey the patient to be mildly dysarthric.
Table 4: Impressions of Subjective Evaluation
Through an in depth evaluation, our client was provisionally diagnosed with mild Dysarthria. The client possessed weakness in the speech musculature. Surprisingly, the weakness commenced after the recovery from COVID-19 infection. However, the client did not have any conventional positive aetiology for his dysarthric component albeit having hypertension. The hypertension as well originated as a post COVID-19 condition. The diffuse parenchymal atrophy reported in the imaging can be attributed to age related neurophysiological alterations. It cannot account for the speech deficits portrayed by the client, as it developed acutely post COVID-19 as opposed to progressive slurring typically reported in age-related speech deteriorations. Furthermore, the peroneal neuropathy reported in the client, would not directly affect speech. Hence, considering all of these facts, we can establish that hypertension was the direct cause of dysarthria. Even though hypertension has been a long-established risk factor for Dysarthria by virtue of its role in cardiovascular incidences, it in itself is rarely considered as the causative agent. Our case report substantiate the finding that hypertension alone can lead to weakness in muscles thereby leading to dysarthria.
The pathophysiology behind these sequelae can stem from the degrading effect of hypertension on the body. As most of the muscles involved in speech are highly vascular in nature, they are immensely vulnerable to the adverse effect of hypertension. The prolonged contraction in these muscles as a response to increased blood pressure can bring about generalized soreness in them, which would result in overall fatigue with mild dysarthric speech. Another major reason that dominates the previous could be that COVID-19 virus interacts with the Angiotensin Converting Enzyme and Angiotensin receptors located in the endothelium thereby altering the pathophysiological functioning of Renin-Angiotensin system (RAS) that regulates the blood pressure. (Wiese, et al., 2020; South et.al, 2020; Amraei & Rahimi, 2020; Lanza et.al, 2020). The altered neurochemical changes in RAS system can bring about atrophy and weakness of muscles, as the RAS axis catalyses major functions like contractile activity and damage control through the regulation of sodium balance, fluids volume, and some other hemodynamic features, of the muscles. (Sukhanov et.al, 2011; Cabello-Verrugio, et al., 2012; Cabello‐Verrugio et.al., 2015). These alterations in the physicality of muscles, could be reflected in diminished functions of the speech subsytems too, because of its motoric nature.
Adding onto this, is the age related changes occurring in the neuromotor system. As age progress the muscles tends to show morphological changes like loss of fibre, loss of mass, reduced tonicity etc. with functional difficulties including reduced rate and range of movement. (Larsson, et al., 1979; Lindle et al., 1997; Jakobi & Rice, 2002; Wilkinson, et al., 2018). As our client is just beginning the fifth decade of his life, these degenarations would not have been severe. Nevertheless, as the neuromotor compensatory skills lessen with increasing age, the COVID-19 infection attack would have made the motoric system more vulnerable, henceforth adding to the already existing weakness.
Hence, compiling all the points of discussion we can effectively point out COVID-19 and post COVID hypertension as causative agent of dysarthria in our client.
Apart from the debilitating and life threatening results of COVID-19 infection, it can also cause secondary conditions like Hypertension, Dysarthria etc. through alteration of systems like RAS. This can hinder the quality of life in the infected patient post recovery. Therefore, it is necessary for us to understand and report these effects and help in rehabilitating these conditions with success.
The study followed the ethical rules and regulation of Kerala University of Health Sciences and was accepted by ethical committee of AWH Special College, Kozhikode. The client was informed and consent was obtained. The study was conducted by maintain proper respect and anonymity towards the client.
We wish to thank our Principal Dr P K Abdul Kader and our Head of the Department Mrs. Girija P C for allowing us to conduct this study. We also appreciate the support of staff and students of AWH Special College that helped us to achieve the completion of this study.
There is no conflict of interest between the authors and the authors as well the client.
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.
