AUCTORES
Globalize your Research
Chat with us
Research Article | DOI: https://doi.org/10.31579/2690-1919/083
1 Full Professor of Psychiatry University of Social Welfare and Rehabilitation Sciences (USWR) Razi Psychiatric Hospital Tehran – Iran.
2 Razi Psychiatric Hospital Tehran – Iran.
*Corresponding Author: Saeed Shoja Shafti, Full Professor of Psychiatry University of Social Welfare and Rehabilitation Sciences (USWR) Razi Psychiatric Hospital Tehran – Iran.
Citation: Saeed Shoja Shafti, Alireza Memarie, Masomeh Rezaie, Behjat Rahimi. Severe Mental Disorder and Comorbid Medical Ailments: A Pilot Enquiry in Aged Schizophrenic Patients. J Clinical Research and Reports, 5(3); DOI:10.31579/2690-1919/083
Copyright: © 2020 Saeed Shoja Shafti. 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: 28 July 2020 | Accepted: 29 August 2020 | Published: 10 September 2020
Keywords: schizophrenia; psychiatric disorders; medical comorbidity; elderly mental patients; senior group of people; chronic patients
Introduction: Comorbidity between mental disorders and physical illnesses is the rule rather than the exception. Approaches to study the impact of comorbidity become challenging also due to lack of consensus about how to define and measure the concept of comorbidity. The aim of the present study was to evaluate the clinical profile of medical comorbidity among a group of local chronic elderly schizophrenic patients to see their prevalence and physiognomies.
Methods: while geriatric section of Razi psychiatric hospital had been selected as the field of investigation, all elderly schizophrenic patients, who have been hospitalized there for lifelong, had been selected as accessible sample and surveyed with respect to recorded checkups and comorbid medical diagnoses. Psychiatric diagnosis was in essence based on ‘Diagnostic and Statistical Manual of Mental Disorders’, 5th edition (DSM-5) and medical diagnosis was principally based on ‘International Classification of Diseases’, 10th edition.
Results: Assessment had been performed on 168 aged schizophrenic patients (≥65 years old), including 101 men and 67 women. According to results, 89% (n=151) of elderly patients had some kind of registered non-psychiatric co-morbidity, which was meaningfully higher than frequency of comorbidity among senior group of local residents. Amongst recorded co-morbidities falls, hypertension and osteoarthritis were the most prevalent comorbidities with a frequency around 48.8%, 44.6% and 39.2%, respectively. Hypertension, renal disease and malnutrition were significantly more prevalent among male patients (p<0.0000, p<0.0045 and p< 0.0018, in turn) and hyponaremia, aspiration/asphyxiation and seizure were meaningfully more prevalent among female patients (p<0.0075, p<0.0000 and p<0.0009, one-to-one). As stated by the findings and in comparison with the senior group of local people while diabetes, renal diseases and malnutrition were significantly more frequent, coronary artery disease, gastrointestinal disorder and osteoarthritis were significantly less frequent among the present sample of elderly schizophrenic patients.
Conclusion: While in comparison with senior group of local people the rate of medical co-morbidities, particularly diabetes, renal diseases and malnutrition, were significantly higher in chronic elderly schizophrenic patients, a significant difference, as well, was palpable regarding the interrelated items between male and female patients, which demands further methodical and gender-based studies to define proper care and interventions for this vulnerable group of patients.
Perhaps, comorbidity between mental disorders and physical sicknesses is the rule rather than the exception (1). It is estimated that although 25% of adult population have mental health illness, 68% of them suffer from comorbid medical disease (2). While readmission rates in psychiatric patients are high and we still lack understanding its likely predictors, physical co-morbidity could be one of important risk factors for psychiatric readmission (2). On the other hand, while the term ‘comorbidity’ is well-acknowledged in research and clinical settings, the idea remains complicated and methodological approaches are different (3). So, there is now no agreement about the definition of comorbidity, which can be defined in several different methods (3). In general, the term comorbidity has three meanings: a) Indicating a medical sickness in a patient existing concurrently but independently with another condition; b) Representing a medical disease in a patient that causes, is caused by, or is otherwise related to another ailment in the same patient; c) Indicative of two or more medical sicknesses in a patient that exist at the same time, regardless of their causative association (4). In an inclusive trial of integrating different aspects of comorbidity, authors have combined different constructs and measures associated with the core concept of comorbidity. Hence, in this respect, four major distinctions were made according to the nature of the health condition, the relative importance of the co-occurring conditions, and the chronology of the conditions: comorbidity, multimorbidity, morbidity burden and patient’s complexity (5, 6). On the other hand, there is growing interest among physicians and scholars in the impact of comorbidity on a range of outcomes, such as mortality, health-related quality of life, patient's functioning, and health care utilization (7). For instance, physical comorbidities, basic demographic data, and clinical variables have shown to much better foretell mortality than the risk of readmission (8). Also, in patients with comorbidities, along with the higher risk of dying, a poorer functional status, quality of life, and a greater use of health services has been recounted (8). These conclusions led to the inference that among patients with comorbidity, the focus of health care should not only be on one particular ailment, but, besides, on the pathology in other organs and on indicators for quality of care, such as complications of management, readmissions, treatment plans and compliance to generally accepted clinical recommendations (9, 10). Earlier studies on patients with serious mental ailment such as long-lasting schizophrenia, bipolar disorder, or protracted recurrent depression, have revealed that these patients have higher mortality rates than persons without serious mental disorder (11). This variance is partially explained as being produced by increases in comorbid medical disorders in the mentally ill, frequently chronic diseases such as diabetes (12) and cardiovascular disease (13). Alternatively, though there is an assumption that patients with serious mental sickness experience a shortened life expectancy due to increased mortality and few of these patients would survive until old age (14), there is now evidence that the numbers of these old mentally ill survivors is increasing (15, 16). As stated by a study, patients with serious mental disorder had significantly higher rates of medical emergency room visits and meaningfully longer lengths of medical hospitalizations than did the primary care control group (17), and for depressed aged persons with at least one chronic medical ailment, improvements in clinical management and harmonization of medical and mental health amenities could moderate the rate of utilization of services (18). Furthermore, as said by another study on senior persons, readmission was most likely among persons with a primary diagnosis of schizophrenia, followed by bipolar disorder, depression, and substance abuse (19). Likewise, comorbid severe mental illness in patients with diabetes is individually linked with greater risk of early medical or surgical re-hospitalization (20). Besides, while health-risk behaviors (e.g., smoking, poor diet, and sedentary lifestyle) contribute to these poor outcomes, treatment with second generation antipsychotic drugs as well has been associated with poorer glycemic control among patients with diabetes (21). Alternatively, patients with serious mental conditions appear to under-utilize primary care services (22) and consequently increase the risk of medical hospitalizations due to possibly avoidable complications (23). Additionally, these patients may be at heightened risk of in-hospital adverse events, too, such as nosocomial infections and postoperative complications (24). Nevertheless, another study had found no increased risk due to these comorbidities (25). The aim of the present evaluation was to appraise the prevalence and physiognomies of medical comorbidities among a group of native elderly schizophrenic patients.
Razi psychiatric hospital in south of capital city of Tehran, as one of the largest and oldest public psychiatric hospitals in the Middle East, which has been established formally in 1917 and with a capacity around 1375 active beds, had been selected as the field of study in the present retrospective assessment. So, amongst its separate existent sections, chronic geriatric section of hospital with a capacity around 220 beds (110 for male and female aged patients, separately) had been designated as the specific field of investigation. Thus, for assessment, all chronic elderly schizophrenic patients (≥65 years old), as accessible sample, had been nominated and estimated with respect to registered checkups and comorbid medical conditions. Psychiatric diagnosis was principally based on ‘Diagnostic and Statistical Manual of Mental Disorders’, 5th edition (DSM-5) (26) and medical diagnosis was principally based on ‘International Statistical Classification of Diseases and Related Health Problems’, 10thRevision (27).
Statistical analysis:
Descriptive statistics including means, standard deviations, and ranges for continuous variables and quantity or percent in each category for categorical variables were calculated for all characteristics. T-tests for continuous data and chi-square tests for categorical data were used to compare the necessary variables between genders or groups. Statistical significance, as well, had been defined as p value ≤0.05. MedCalc Statistical Software version 15.2 was used as statistical software tool for analysis.
According to the findings, the current assessment of elderly schizophrenic patients had been performed on one hundred and sixty-eight patients, including one hundred and one males and sixty-seven females, who had been hospitalized in the chronic section of the hospital for long-life. Mean age (±SD) of the patients were around 69.12 ± 8.93 and 74.69 ± 6.54 for male and female patients, respectively, which was significantly shorter for male patients [t = -4.383, p < 0.00, CI 95% = -8.08, -3.06]. As said by results, nearly 89% (n=151) of aged patients had some kind of registered non-psychiatric co-morbidity, usually between one to four problems, that required specific care by a primary care physician or specialist, and so had received related standard cares, visits and treatments, on a regular basis (Table 1).
Co-morbidity | Number | Percentage |
Falls | 82 | 48.8 |
Hypertension | 75 | 44.6 |
Osteoarthritis | 51 | 30.3 |
Malnutrition | 64 | 30 |
Aspiration / Asphyxiation | 49 | 29.1 |
Prostate enlargement | 28 | 27.7 |
Diabetes | 39 | 23.2 |
Seizure | 34 | 20.2 |
Renal disease | 33 | 19.6 |
Bed sore | 30 | 17.8 |
Hyponatremia | 27 | 16 |
Coronary artery disease | 25 | 14.8 |
Gastrointestinal disorder | 14 | 8.3 |
Cataract | 14 | 8.3 |
Hypothyroid | 13 | 7.7 |
Chronic obstructive pulmonary disease | 13 | 7.7 |
Liver disease | 13 | 7.7 |
Anemia | 9 | 5.3 |
Congestive heart failure | 7 | 4.1 |
Cancer | 7 | 4.1 |
Stroke | 5 | 2.9 |
Hyperthyroid | 5 | 2.9 |
Parkinson disease | 5 | 2.9 |
Brain cyst | 1 | 0.5 |
Table 1- Prevalence of medical co-morbidities among elderly schizophrenic patients.
This amount of medical comorbidity was significantly higher in comparison with the local aged group of people with about 80% comorbidity (z= -3.2458 , p<0.0012, CI 95%=-0.1761,-0.0435) (28) (Table 2).
Comorbidity | Elderly schizophrenic patients (Percentage) | Senior group of local people (Percentage) | Z | P | CI |
Diabetes | 23.2% | 15.6% | 2.36 | 0.01 | -0.14,-0.01 |
Hypertension | 44.6% | 41.5% | 0.75 | 0.44 | -0.11,0.05 |
Chronic obstructive pulmonary disease | 7.73% | 10.8% | 1.18 | 0.23 | -0.02,0.08 |
Coronary artery disease | 14.8% | 37.5%
| 5.07 | 0.00 | 0.12,0.28 |
Renal disease | 19.6% | 6% | 5.62 | 0.00 | -0.18,-0.08 |
Malnutrition | 30% | 5.8 % | 11.32 | 0.00 | -0.37,-0.26 |
Gastrointestinal disorder | 8.33% | 45.89% | 8.92 | 0.00 | 0.29,0.45 |
Osteoarthritis | 30.35 | 79.2 | 12.74 | 0.00 | 0.42,0.58 |
Table 2 – Elderly schizophrenic patients versus senior group of local people, as regards the frequency of medical co-morbidities.
Listed co-morbidities included diabetes , hypertension, falls, congestive heart failure, chronic obstructive pulmonary disease, osteoarthritis , cancer , coronary artery disease, liver disease, renal disease, stroke, thyroid disease, bed sore, aspiration/asphyxiation, seizure , hyponatremia , malnutrition , anemia , gastrointestinal bleeding , prostate enlargement , cataract, Parkinson disease and brain cyst (Table 1). Among them falls, hypertension and osteoarthritis were the most prevalent disorders with a percentage around 48.8%, 44.6% and 30.35%, respectively (Table 1). The next co-morbidities included malnutrition (30%), aspiration / asphyxiation (29.1%), prostate enlargement (27.7%), diabetes (23.2%), seizure (20.2%), renal disease (19.6%), bed sore (17.8%), hyponatremia (16%), coronary artery disease (14.8%), gastrointestinal disorder (8.33%), cataract (8.33%), liver disease (7.73%) and hypothyroidism (7.73%). The remaining co-morbidities, including congestive heart failure, chronic obstructive pulmonary disease, cancer, stroke, anemia, Parkinson disease and brain cyst, were less than six percent, individually. As said by the findings, hypertension, renal disease and malnutrition were significantly more prevalent among male patients (p<0.0000, p<0.0045 and p< 0.0018, in turn) and hyponaremia, aspiration/asphyxiation and seizure, were significantly more prevalent among female patients (p<0.0075, p<0.0000 and p<0.0009, one-to-one) (Table 3).
Comorbidity | Males (n=101) | % | Females (n=67) | % | Z | P | CI |
Diabetes | 28 | 27.7 | 11 | 16.4 | 1.69 | 0.08 | -0.01,0.24 |
Hypertension | 60 | 59.4 | 15 | 22.3 | 4.72 | 0.00 | 0.21,0.52 |
Falls | 47 | 46.5 | 35 | 52.2 | 0.72 | 0.46 | -0.21,0.09 |
Congestive heart failure | 4 | 3.96 | 3 | 4.47 | 0.16 | 0.86 | -0.06,0.05 |
Chronic obstructive pulmonary disease | 8 | 3.9 | 5 | 2.9 | 0.10 | 0.91 | -0.07,0.08 |
Osteoarthritis | 29 | 28.71 | 22 | 32.83 | 0.56 | 0.56 | -0.18,0.10 |
Cancer | 4 | 3.9 | 3 | 4.4 | 0.16 | 0.86 | -0.06,0.05 |
Coronary artery disease | 13 | 12.8 | 12 | 17.9 | 0.89 | 0.36 | -0.16,0.05 |
Liver disease (hepatitis) | 9 | 8.9 | 4 | 5.97 | 0.69 | 0.17 | -0.05,0.11 |
Renal disease | 27 | 26.7 | 6 | 8.9 | 2.83 | 0.00 | 0.05,0.30 |
Stroke | 4 | 3.9 | 1 | 1.4 | 0.92 | 0.35 | -0.02,0.07 |
Hyperthyroid | 3 | 2.97 | 2 | 2.98 | 0.005 | 0.99 | --0.05,0.05 |
Hypothyroid | 8 | 7.92 | 5 | 7.46 | 0.10 | 0.91 | -0.07,0.08 |
Bed sore | 14 | 13.8 | 16 | 23.8 | 1.66 | 0.09 | -0.21,0.01 |
Aspiration / Asphyxiation | 17 | 16.8 | 32 | 47.7 | 4.31 | 0.00 | -0.44,-0.16 |
Seizure | 12 | 11.8 | 22 | 32.8 | 3.31 | 0.00 | -0.33,-0.08 |
Hyponatremia | 10 | 9.9 | 17 | 25.3 | 2.67 | 0.00 | -0.26,-0.04 |
Malnutrition | 50 | 49.5 | 14 | 20.8 | 3.12 | 0.00 | 0.09,0.39 |
Anemia | 5 | 4.9 | 4 | 5.9 | 0.28 | 0.77 | -0.07,0.05 |
Gastrointestinal disorder | 9 | 8.91 | 5 | 7.46 | 0.33 | 0.73 | -0.07,0.09 |
Prostate enlargement | 28 | 27.7 | - | - | - | -- | - |
Cataract | 8 | 7.92 | 6 | 8.95 | 0.23 | 0.81 | -0.09,0.07 |
Parkinson disease | 3 | 2.97 | 2 | 2.98 | 0.00 | 0.99 | -0.05,0.05 |
Brain cyst | 1 | 0.9 | 0 | 0 | - | - | - |
Table 3 –Prevalence of medical co-morbidities among male and female elderly schizophrenics.
According to the findings and in comparison with the senior people of local people, while diabetes, renal diseases and malnutrition were significantly more frequent, coronary artery disease, gastrointestinal disorder and osteoarthritis were significantly less frequent among the present sample of chronic old schizophrenic patients (Table 3).
While the co-occurrence of mental and physical conditions is very common in clinical settings, the exact nature of relationship between them is very complex and hitherto not well understood (29). So far, very little work has been done on medical comorbid disorders among patients with mental illnesses since comorbidity was rarely the main objective of studies (5). Additionally, while comorbidity is generally associated with mortality, consequences of specific disease combinations depend on many issues (11). It is clear that in elderly people, each body system undergoes changes, which occur over many years and are considered normal among senior people (10) However, these changes often place the elderly persons at high risk for the development of various diseases (15). So, it is very important to differentiate normal from pathological alterations in order to prevent wrongly treatment of normal changes and failing to treat those that result from ailments (29). Back to our discussion and with respect to clinical profile of medical comorbidity among senior schizophrenic patients, almost most of patients had some kind of registered non-psychiatric co-morbidity that demanded specific attention by a primary care physician or specialist. Thus, in comparison with senior group of local people (28) a significantly higher proportion of comorbidity was evident among the present sample. Such a finding was in harmony with the outcomes of Brown et al. (12)., Andrés et al. (5)., and Vigod et al. (7)., who believed that psychiatric patients have been widely reported to be at an increased risk of morbidity and mortality due to physical disorders and comorbidity between medical and mental disorders is the rule rather than the exception. But it was not in harmony with the conclusions of Daumit et al. (25), who had found no significant increased risk of morbidity or mortality associated with the presence of these comorbidities in severe mental patients. Besides, among the listed comorbidities in current assessment, falls, hypertension and osteoarthritis were the most prevalent medical complications. These outcomes are partially consistent with the findings of Hendrie et al. (17), who had found hypertension, osteoarthritis and diabetes as the most prevalent medical comorbidities among aged mental patients. But in contrary to him, in the present assessment there was not any significant difference regarding prevalence of hypertension between the present sample of schizophrenics and senior group of local people. Besides, while his claim regarding higher prevalence of falls in comparison with the primary care controls was not approvable here, due to deficiency of reliable native recording, falls was meaningfully higher among our patients, in comparison with other recorded items. Anyhow, the impact of demographic variances should not be ignored, since his samples included more females, a variety of ethnic groups and outpatients from primary care clients, while our samples included more males, single ethnic group (Persians), and only inpatients. Also with respect to other major co-morbidities in the present assessment, like malnutrition, diabetes, seizure, renal disease, coronary artery disease, gastrointestinal disorder and hypothyroidism , our findings were to some extent in harmony with reports of Zubenko et al. ( 30 ), Zgueb et al. ( 31 ), Räsänen et al. (32 ), Gausset et al. ( 33 ), Lim et al. ( 34 ), Hewer et al. ( 35 ), Tabbane et al. (36 ), Abiodun et al. ( 37 ) And Kamara et al.(38 ), who had found, as a general rule, infections, lung, gastrointestinal, urogenital and cardiovascular diseases as the most prevalent medical comorbidities among severe mental patients; Because they were comparable only with respect to urogenital and cardiovascular diseases. Our results regarding the remaining rarer co-morbidities, like congestive heart failure, chronic obstructive pulmonary disease, cancer and stroke, again, were not coherent with the outcomes of Hendrie et al. (17) and Tabbane et al. (36). Furthermore, since medical problems like, bed sore, aspiration/asphyxiation, seizure, hyponatremia and malnutrition, had not been pointed out or surveyed in the parallel studies, further assessment becomes difficult. On the other hand, as said by the conclusions of the current evaluation, hypertension, renal disease and malnutrition were significantly more prevalent among male patients and hyponaremia, aspiration/asphyxiation and seizure, were meaningfully more prevalent among female patients, which may display a gender-based difference in this regard. While such a difference could depend partly on the route of care, and somewhat on biological grounds, it may perhaps offer facts for future studies, too. Likewise, in comparison with the local senior persons, diabetes, renal diseases and malnutrition were significantly more frequent among the present sample of chronic elderly schizophrenic patients, a finding which was again, unharmonious with the findings of Hendrie et al. (17). Anyhow, while the impact of physical comorbidity on psychiatric readmission is still unsatisfactorily investigated problem, there is a growing interest among specialists and academics in the impact of physical comorbidity on a variety of outcomes in mental disorders, such as mortality, health-related quality of life and health care spending, which is noticeably higher for patients with comorbid disorders (10). The comorbidity of mental and physical disorders is on the increase and as pointed out by Sartorius this topic is becoming a main challenge to medicine in the 21st Century (14). Future research should address these topics with more in-depth studies since new understandings in this field could lead to better prevention approaches to reduce psychiatric readmissions (15). In this regard, teaching regarding the normal changes of aging should be the first intervention made with all aging adults to help them understand what is going on in their bodies. In addition, many interventions are available to compensate for these changes as well as to prevent the development of disease as a consequent of these interventions (29). Short duration of assessment, small sample size, restriction of study to a single academic center and lack of parallel and concomitant control groups, were among the weaknesses of the present evaluation. Surely, further methodical researches are needed to define proper care and interventions for this vulnerable group of patients.
While in comparison with senior group of local people the rate of medical co-morbidities, particularly diabetes, renal diseases and malnutrition, were significantly higher in chronic elderly schizophrenic patients, a significant difference, as well, was palpable regarding the interrelated items between male and female patients, which demands further methodical and gender-based studies to define proper care and interventions for this vulnerable group of patients.
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.
