AUCTORES
Globalize your Research
Chat with us
Editorial | DOI: https://doi.org/10.31579/2641-0419/041
1* Department of Cardiology, Servergazi State Hospital, Denizli, Turkey
*Corresponding Author: Sara Cetin Sanlialp, Department of Cardiology, Servergazi State Hospital, Denizli, Turkey.
Citation: Sara C. Sanlialp., (2020) The Cardiovascular Effects of Energy Drinks. J.Clinical Cardiologyand Cardiovascular Interventions, 3(1); Doi:10.31579/2641-0419/041
Copyright: © 2020 Sara Cetin Sanlialp, 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: 18 December 2019 | Accepted: 31 December 2019 | Published: 03 January 2020
Keywords: cardiovascular effects; energy drinks
Energy drinks are generally consumed by young people to increase athletic performance and concentration. Energy drinks contain high concentrations of caffeine, sugar, vitamin B complex, taurine, ginseng and guarana. There are not enough studies on these stimulants but past case-reports and small studies about energy drinks have been associated with cardiovascular complications. Especially with the use of alcohol or abuse drugs increase their undesirable effects and it may lead to cardiac morbidity and mortality. In this review, we aimed to focus on the effects and complications of energy drinks on the cardiovascular system.
Energy drinks are one of the most frequently consumed drinks especially by young people in today. The production of energy drinks started in the 1960s and gradually increased in popularity [1]. Due to its fast growing market, industrial centers interested in the production of beverages are increasing day by day [2]. Energy drinks are often used to increase weight loss, athletic performance and concentration. The most popular brands in the USA are Red Bull, Rockstar, Monster, Full Throttle and Amp [3]. Energy drinks included caffeine, ginseng, taurine, guarana, B vitamine complex and sugar. Although there are more brands in markets, their components are not more different each others [4].
Energy drink generally contains 0.34 mg of caffeine, it has approximately 2-4 times more caffeine components from tea and soda. Although there is no specific consensus on the upper limit of daily caffeine consumption, it has been reported that caffeine can be safely consumed up to 400 mg per day [5]. The use of Red Bull has been banned in France but the prohibition has been removed because of the lack of evidence of its toxicity by the European Union [6]. However, the number of visits to the emergency department has been increased due to the adverse events that occurred depending on the substances contained in these beverages [7]. It has been reported that the consumption of energy drinks may be associated with various medical complications such as seizures, anxiety, agitation, hallucinations, migraines, pontine myelinolysis, gastrointestinal upset, rhabdomyolysis, metabolic acidosis, insomnia, arrhythmias, chest pain, and cardiovascular complications [8]. Especially the use of energy drinks together alcohol or drugs may increase the potential effects of energy drinks [9].Moreover, cardiovascular changes caused by energy drinks may cause morbidity and mortality [10].
The components of energy drinks:
Caffeine is the cornerstone of energy drinks and energy drink contains various ingredients that cause stimulant effects. The other components are guarana, taurine, theophylline, ginkgo biloba, ginseng, vitamins, L-carnitine [11].
Caffeine is a methylxanthine derivative that causes activation in the sympathetic nervous system.Although there are many studies on the cardiovascular effects of caffeine, unfortunately the results are contradictory. Caffeine causes positive inotropic effects on miyocardium with inhibiton of phospodiesterase enzyme and in contrast, caffeine causes vasoconstriction by inhibiting adenosine inhibition, platelet aggregation, catecholamine and renin secretion. Caffeine may trigger endothelial dysfunction through sympathetic activation.The effects of caffeine on arrhythmia are variable.The use of overdose may trigger arrhythmia.However, there are many conflicting studies on the effects of caffeine on arrhythmia.Furthermore, the different cardiovascular effects of caffeine on people may be due to the CYP1A2 enzyme gene polymorphism, which is responsible for the primary metabolism of caffeine and the caffeine dose [6].
Taurine: Taurine is an amino acid derivative and is highly present in the heart and skeletal system [12]. Taurine causes negative chronotropic effects by reducing myocaridal calcium sensitivity. It provides vasodilation by suppressing the angiotensin 2 system. The caffeine consumption improves lipid profile by increasing LDL receptor upregulation and LDL uptake into the liver [13,14].
Ginseng is one of the populer plants grown in eastern Asia.This plant has stress-reducing, diabetes-healing, erectile dysfunction relief and memory-improving benefits [15]. It has been shown that it increases energy level and contributes to physical performance [16].But excessive consumption can cause drowsiness, headache, agitation, dizziness, hypertension [17].
L-carnitine is a naturally occurring amino acid produced predominantly by the liver and kidneys.It plays a role in beta oxidation of fatty acids so it can lead to changes in energy metabolism.It is also involved in the suppression of programmed deaths of immune cells, in the prevention of cellular damage and in the stimulation of hematopesis [18]. Studies have shown that the cardiovascular effects of ginseng are contradictory.In one of the studies, it was shown that ginseng contributed to atherosclerosis but in another study it was claimed that left ventricular remodeling decreased [19, 20].
1) Elevated blood pressure: Many studies have shown that energy drinks may increase blood pressure. In a study, 3 different energy drinks and placebo were presented volunteers one our before the test and their blood pressure were measured 15 minutes after the test. The blood pressures of the participants drinking 3 different energy consumed (163.87 mmhg, 166.47 mmhg, and 165.00 mmhg ) were higher than placebo (156 mmhg ) [21]. In another study, Stein et al. reported that blood pressure and heart rate may elevate a few hours after consumption of the energy drinks [22]. In another study, the redbull energy drink has been elevated blood pressure by increasing cardiac output on echocardiography [23]. Consumption of energy drinks in healthy individuals may trigger small fluctuations in blood pressure but blood pressure returns to normal after discontinuation of consumption. But this status may be deferred or difficult in hypertensive patients, so hypertensive individuals should avoid consumption of energy drinks [24].
2) Increased heart rate: The comsumption of energy drinks may increase heart rate., In a study with volunteers, blood pressure, heart rate and electrocardiograms of the participants were measured 48 hours after consumption of energy drink. Although there was no significant change in the electrocardiograms of the participants, their blood pressures increased by 10 mmhg and heart rate by 7 beats [22].
3) Cardiac arrhythmia: Components in energy drinks may trigger supraventricular arrhythmias, especially atrial fibrillation in young people. This hypothesis is controversial, although genetic predisposition has been suggested as to who triggers atrial fibrillation [25]. In a case report, a young patient presented to the emergency department with chest pain and palpitation after taking energy drink The electrocardiography was consistent with supraventricular tachycardia attack. Vagal maneuver and carotid sinus massage were not successful. The patient returned to sinus rhythm only after adenosine was applied [26]. Nevertheless there is no evidence that chronic energy drink consumption triggers arrhythmia. Several reasons have been proposed about the mechanisms by which energy drink consumption can trigger ventricular arrhythmia. These are increased levels of circulating cathelolamine, causing dose-proportional hypokalemia and suppressing sodium channel conduction [27]. Patients with ventricular arrhythmia usually have underlying structural heart disease, cardiomyopathies and canalopathies [28].
4) QT prolongation: Studies showing the effect of energy drink consumption on electrocardiogram are few and contradictory. In a study with healthy volunteers, it was observed that the energy drinks temporarily prolonged the QTc duration by 10-20 ms. However, QTC duration was prolonged more than 50 ms in two volunteers. But none of the components of the energy drink are stimulant enough to trigger ventricular arrhythmia. Only an uncommon cause of sudden cardiac arrest secondary to ventricular fibrillation in some individuals may be underlying canopathies [29]. In a previous report record, a 22-year-old woman applied to emergency service with torsades de pointes after consuming 6 cans of energy drink in four hours. The patient was followed up in the intensive care unit and the QTc interval, which was initially 526 ms, decreased to 419 ms. KCNQ1 mutation causing long QT syndrome type 1 was detected in the patient's genetic test [30].
5) Coronary artery vasospasm: Energy drink may cause coronary artery vasospasm by accelerating calcium flow from smooth muscle cells with inhibition of adenosine receptor and increasing catecholamine release. Taurine can disrupt intracellular and extracellular classium signal flow at toxic levels [31,32]. A 27-year-old man admitted to the emergency department with chest pain and ST elevation myocardial infarction was detected in him. When intrcoronary nitroglycerin and verapamil were administered to him, the coronary arteries were detected normal and the patient was diagnosed with vasospastic angina [33].
6) Coronary artery thrombosis and dissection: Concomitant use of alcohol and energy drink may cause coronary artery thrombosis. In one reported case, a young patient presented with typical retrosternal pain and underwent angiography because of elevated troponin and electrocardiogram findings and. Several thrombi were detected in the patient. [34] In another case-report, echocardiography revealed apical hypokinesia in a patient admitted to the emergency department with chest pain and electrocardiogram changes. Angiography determined dissection of the left anterior descending artery in patient [35].
7) Aortic Dissection: There are very few pretentious case-reports that the energy drinks may cause aortic dissection. The triggering mechanism of aortic dissectionhas been estimated to be an increase in caffeine-induced acute blood pressure [36].
8) Sudden Cardiac Death: The energy drink consumption before physical performance may increase the oxygen demand of miyocardium during physical performance. This situation may be concluded by fatal arrhythmias secondary to ischemia, resulting in sudden cardiac death [5].
9) Miyocardial infraction: Caffeine inhibits adenosine receptors and increases catecholamine release. Caffeine alone may not contribute sufficiently to the development of atherosclerosis but other components of the energy drink may contribute to this process. In a study with healthy participants, endothelial function and platelet aggregation were evaluated after consuming energy drinks. The result of study, it has been claimed that energy drinks may contribute developing small amount of endothelial dysfunction and increasing 14% platelet aggregation [37, 38]. In another case-report, 26 age male patient consuming 8-10 energy drinks per a day was admitted to the catheter laboratory with the diagnosis of inferior STEMI and the circumflex artery was 100% occluded in patient. The balloon angioplasty with drug-coated stent was applied to the guilty lesion [36].
The previously reported records and small studies suggest that energy drinks may be associated with arrhythmia, QT prolongation, myocardial ischemia and infarction, aortic dissection etc. In particular, the cardiovascular effect of these beverages may be more pronounced in young people with underlying structural heart disease, cardiomyopathy, and canalopathy. By prohibiting or restricting the legal production and sale of these beverages, cardiovascular complications of energy drinks can be prevented. However, further investigations and randomized controlled trials are needed to initiate this legal process and to determine the precise effects of these beverages on cardiovascular health.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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
