AUCTORES
Globalize your Research
Research Article
*Corresponding Author: Ninel Revenco MD, PhD, Professor. Head of Department of Pediatrics, State University of Medicine and Pharmacy, “Nicolae Testemitanu”, Republic of Moldova. *With advisory support: Ilie Vasiliev MD, Professor at the World Academy of Medical Sciences. First
Citation: N Revenco, E Rodica, F Silvia, Balanuta A Mihaela, I Vasiliev, et al. (2021) SARS-COV-2/COVID19 Induce Kawasaki-Like Disease in Children Experience of Republic of Moldova: A Report of Five Cases. Biomedical Research and Clinical Reviews. 3(3); DOI: 10.31579/2692-9406/055
Copyright: ©2021 Ninel Revenco & Ilie Vasiliev, 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: 24 February 2021 | Accepted: 06 March 2021 | Published: 10 March 2021
Keywords: kawasaki disease; sars-cov-2; multi-systemic inflammatory syndrome; child clinical case
Infection with SARS-CoV-2 virus is a serious challenge for the entire medical and scientific community. Medical institutions are facing record numbers of patients and conflicting claims about SARS-CoV-2 and due to its mutagenic properties, thanks to the D614G protein from Coronavirus (CoV) defining the determines the mutagenicity of SARS - CoV and MERS-CoV [1,2]. With the expansion of the COVID-19 Pandemic, researchers have reported [3] clinical cases of multisystemic inflammatory syndrome in children (MIS-C), similar to Kawasaki disease (KD). Due to the absence of a diagnostic marker for KD, the latter is established according to the criteria of the American Society of Cardiology, in this situation with associated SARS-CoV-2 infection. We deem it appropriate to report five clinical cases of KD that met the criteria for defining an MIS-C case as defined by WHO.
Case reports are valuable resources, essential prerequisites for developing critical thinking based on medical experience. Although the first published studies reported a relatively mild benign course of SARS-CoV-2 infection in children, a new presentation of Covid-19 appears in the pediatric population in late April / early May 2020, as childhood MIS-C is temporarily associated with SARS-CoV-2 infection, which has characteristics similar to those of other inflammatory conditions in children, such as KD, staphylococcal and streptococcal toxic shock syndrome, bacterial sepsis, macrophage activation syndrome. It can also manifest itself with excessively high levels of inflammatory markers and abdominal syndrome, which can mimic appendicitis or typhoid fever [4].
It is known that medical studies have identified about 30 different types of vasculitis, the triggering mechanism of which is endothelins generated by genetic [5,6] and immunocompromising (IC) CHAOS - [C]ardiovascular Compromise: shock; [H]omeostasis; [A]poptosis; [O]rgan Dysfunction; [S]uppression of the Immune System with the development of SIRS (Systemic inflammatory response syndrome) [7,8], Multiple Organ Dysfunction Syndrome (MODS), HELLP-syndrome [H](Hemolysis) [EL](Elevated liver enzymes) [LP](Low platelet count)] [9-11]. KD is one of the most common acute systemic vasculitides in children, affecting medium-sized arteries, especially coronary arteries; the clinical picture describes an acute onset with high fever, generalized polymorphous exanthema, palmar-plantar erythema, symmetric nonsuppurative conjunctivitis, usually unilateral cervical lymphadenopathy, which lasts about 12 days, and enanthem of the mucous membrane with redness and chapped lips [12].
The etiology, immunology, and pathophysiology of KD are poorly understood, although elements of the immune system play a key role [13]. KD, in both its typical and atypical manifestations, has been described as associated with infectious agents such as Streptococcus pyogenes, Staphylococcus aureus, and Yersinia pseudotuberculosis, as well as with viral infections such as adenoviruses, enteroviruses, Epstein-Barr virus (EBV), and non - SARS-CoV-2 [14,15], and approximately 2% of children may develop macrophage activation syndrome [16].
Scientists have concluded that KD is the leading cause of coronary heart disease in the pediatric population. The most alarming complication of KD is aneurysmal dilatation of the coronary arteries, which can be detected by echocardiography starting from the 2nd week of the recovery stage [13]. Recently, several scientific journals have published a series of KB cases associated with SARS-CoV-2 infection, among which the cases are reported in the Republic of Moldova [3], Great Britain, Italy, France, USA, Turkey [17-22].
Purpose of the study. To provide an overview of the main features of Kawasaki disease and to promote the early recognition, diagnosis, and treatment of KD in our country.
Materials and methods
This is a single-center, prospective observational study. This case series report describes five pediatric patients with MIS-C who were hospitalized between April 22 and October 9, 2020, at the Institute of Mother and Child of the Republic of Moldova. Variables analyzed included anamnestic data, demographic information, general clinical manifestations, epidemiological data confirming susceptibility to SARS-CoV-2 infection, laboratory and imaging studies, and the evolution of the disease by the applied therapeutic tactics.
The MIS-C patients enrolled in the study met the recently revised WHO definition of children and adolescents 0 to 19 years of age with fever ≥ 3 days, plus 2 of the following: a) Rash or bilateral nonsuppurative conjunctivitis or signs of mucosal inflammation. (oral, hands, feet); b) Hypotension or shock; c) characteristics of myocardial dysfunction, pericarditis, valvulitis, or coronary artery abnormalities, including imaging data (echocardiography) and laboratory tests (elevated troponin and/or NT-proBNP levels); d) Evidence of coagulopathy (eg, increased prothrombin time / INR, time of partially activated thromboplastin, D-dimer levels); e) acute gastrointestinal symptoms (vomiting, diarrhea) or abdominal pain; and Elevated markers of inflammation, such as Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) , or procalcitonin, and absence of other obvious microbial causes of inflammation, including bacterial sepsis, staphylococcal or streptococcal shock syndrome, and Proof of COVID-19 Reverse transcription polymerase chain reaction (RT-PCR), positive serological tests, or possible contact with patients who test positive for COVID-19.
KD was defined according to the criteria of the American Society of Cardiology, including both classic types (fever ≥ five days plus four or more of the following clinical criteria: non-exudative bulbar conjunctivitis, lip or oral mucosa changes, non-purulent late cervical lymphadenopathy, erythematous polymorphic skin rash, erythema of the palms or soles, hard induration of the hands or feet, or both for complete disease and fever for ≥ five days plus 2 or 3 clinical criteria mentioned for incomplete type).
Results. The five patients with a diagnosis of MIS-C similar to KD ranged from 8 months to 10 years of age. When considering the gender distribution, the prevalence of women (80%) over men (20%) was noted.
All patients included in the study had at least one evidence of SARS-CoV-2 infection, 2 (40%) of whom tested positive by RT-PCR in a nasopharyngeal swab. In contrast, the remaining 3 (60%) showed positive serological data for anti-SARS-CoV-2 IgG and IgM. Patients 3 and 5, along with serologic evidence of SARS-CoV-2 infection, also presented serologic evidence of latent EBV infection. Clinical manifestations at admission to the hospital included persistent drug-resistant fever, polymorphic skin rash without blistering or crusts and no itching, signs of peripheral skin inflammation manifested by palmar or plantar erythema, and abdominal pain in 100% of cases. Four (80%) out of five patients had non-exudative bulbar conjunctivitis and signs of damage to the oral mucosa manifested as redness and cracked lips, a raspberry tongue with hypertrophied papillae, and diffuse oropharyngeal erythema. Unilateral cervical lymphadenitis occurred in patients 1, 2, and 3 (60%); in inpatient 4, bilateral cervical lymphadenitis was found, in the fifth, it was not detected. In patients 2 and 5, at the onset of the disease, clinical manifestations of the digestive system were also observed, expressed in diarrhea and single vomiting.
When analyzing the results of laboratory studies, an increase in the number of reactants of the acute phase of inflammation was revealed in 100% of cases, which is different for each case. Thus, ESR and hyperfibrinogenemia were recorded in 60% of cases, while in 100% of cases, an increase in CRP was observed, the values of which varied from 12 to 96 mg. / L. In the early stages of the disease, leukocytosis was present in 80% of patients, neutrophilia in 60%, lymphopenia and anemia in 80%, which returned to control values during treatment. In 40% changes in the platelet count showed thrombocytopenia, and in 60% thrombocytosis, as well as the transition from thrombocytopenia to thrombosis. Other changes were nitrogen retention syndrome, manifested by elevated serum creatinine and urea levels in 40%, increased liver transaminases in 20%, and an increase in the MB level of creatine kinase in 80%. Along with nitrogen retention syndrome, minor proteinuria was also observed, which was negative during therapy with corticosteroids. Echocardiographic studies performed during hospitalization in 80% of cases did not reveal signs of impaired myocardial contractility, pericardial perfusion, or aneurysmal dilatation of the coronary arteries. The detected changes in the diameter of the coronary arteries during ultrasound examination of the heart were supplemented by angiographic magnetic resonance imaging of the heart to exclude aneurysmal expansion of the heart. The electrocardiogram revealed an extended QT interval. 80% of patients had typical imaging signs of unilateral or bilateral pneumonia found on chest x-ray, although respiratory symptoms were mild.
All 5 cases required at least 24 hours of observation in the intensive care unit; the second patient also needed oxygen support. Treatment included corticosteroids, antibiotics, antiplatelet drugs, and symptomatic therapy as appropriate. In 100% of cases, the therapeutic response was positive. The patients were discharged with a recommendation to return later to check the long-term course of the disease and early detection of possible complications specific to KD that may occur remotely. To date, none of the patients included in the study have developed any complications.
Initially, SARS-CoV-2 infection in children was reported to be mild, with few ICU admissions and very few deaths. Children infected with SARS-CoV-2 may develop asymptomatic or may have a fever, respiratory and gastrointestinal symptoms [23]. As of April 2020, in the United Kingdom, scientists have determined that children with persistent fever, elevated acute phase reagents (neutrophilia, elevated PCR, and lymphopenia), one or more organ dysfunction like MIS-C compared to SARS-CoV-2. The phenotypes in this category are typical or atypical KD, KD shock syndrome, toxic shock syndrome, and macrophage activation syndrome (MAS) [24]. In this study, we analyzed only a group of patients who met the criteria for typical or atypical KD associated with COVID-19. The temporal relationship between clinical and paraclinical manifestations of MIS-C and the presence of laboratory evidence of SARS-CoV-2 infection in five children included in our small cohort supports the etiopathogenetic hypothesis that this syndrome is the result of a post-infectious immune response. According to recent reports, childhood MIS-C often begins 1–6 weeks after SARS CoV-2 infection and may overlap with an acute respiratory manifestation of COVID-19 [24].
In our cohort, the most common clinical manifestations were drug-resistant prolonged febrile syndrome and skin syndrome. Fatigue, myalgia, arthralgia, headache, often described in adults, were less pronounced in children, which could be explained by their inability or difficulty in reporting them (60% of patients included in our study were under five years of age or had difficulty expressing). tongue). Although our patients showed signs and symptoms characteristic of KD, such as fever, rash, changes in the oral mucosa, conjunctivitis, cervical lymphadenopathy, thrombocytosis (in the later stages of the disease), there were some differences from classical KD, such as affecting older children, affecting the respiratory system (confirmed by imaging), gastrointestinal disturbances, lymphopenia and thrombocytopenia, which in some cases progressed to thrombocytosis. KD is a clinical diagnosis and there is currently no specific diagnostic test. It may present atypically as KD shock syndrome and rarely as macrophage activation syndrome. McCrindle BW et al. believe that CD may be a manifestation of a genetic predisposition to an abnormal immune response to some specific infectious agents [25].
Renal failure, expressed by nitrogen retention syndrome and mild proteinuria, registered in patients 2 and 5, can be explained by the presence of SARS-CoV-2 receptors type ACE 2 in the kidneys. At the same time, these two patients also had clinical manifestations of digestive disorders, expressed by diarrhea and vomiting in patient 2, which indicates a prerenal lesion. The proposed specific mechanisms of secondary COVID-19 kidney damage are associated with ACE 2 (angiotensin-converting enzyme 2) receptors, which are recognized as SARS-CoV-2 receptors and are located on the surface of epithelial cells in the lungs, heart, and kidneys, gastrointestinal system, testes, basal epidermal cells and hair follicles, and cells of the central nervous system. Thus, the S1 subunit of the viral protein S binds to the ACE-2 receptor, activating angiotensin II. Puelles VG et al. argue that co-expression of ACE-2 and TMPRSS2 plays an important role in facilitating entry into the genome [26]. Through viral invasion, SARS-CoV-2 can have a direct cytopathic effect on renal cells [26]. One of the earliest studies to identify kidney damage associated with SARS-CoV-2 infection is the study by DJ Stewart et al. In Great Britain. According to this study, about half of the 52 children hospitalized with COVID-19 showed signs of renal dysfunction, and about a quarter of them met the criteria for acute kidney injury [27]. Along with the ACE-2 pathway, it will also be important to determine and another pathway [28] for the penetration of coronavirus into the cell in children through a molecule, the cluster of protein differentiation (CD147) [also called extracellular matrix metalloproteinase inducers (EMMPRIN) or Basigin (BSG) and belonging to the superfamily immunoglobulins]. As well as the features of the development of Oxidative and Nitro-Halogenic stress in children with SARS-Cov2 / COVID / 19 with the Cyto-destructive effect of membrane lipid peroxidation [28], the syndrome of electro- ionic membrane distress (syndrome of Maria&Irina Vasilieva) [29-32] and prevalence of SIRS over CARS in successful resuscitation in critically ill adult patients infected with SARS-CoV-2 [1,2,28] with support: respiratory [33], cardiac [34] and cerebral [35-39]. In children, the manifestation of Nitro-Halogen stress could explain the development of aneurysmal dilatation of the coronary arteries due to the slower action of the antiproliferative effect of NO (reactive nitrogen species, RNS) on the smooth muscle cells of the vascular wall.
Four out of five children included in the study showed signs of myocardial inflammation, expressed by an increased content of creatine phosphokinase MB, and in the fifth patient, driving disorders were also recorded on electrocardiography due to prolongation of the QT interval, which disappeared during the next hospitalization. The pathogenesis of myocardial injury associated with COVID-19 in children is unknown. A recent Chinese study shows that SARS CoV-2 is much less common in children due to lower ACE2 levels than in adults [40]. Cui et al. reported acute myocarditis associated with SARS-CoV-2 infection in a 55-day-old infant who had elevated cardiac troponin levels on admission [41]. Another study describing heart failure in MIS-C is being conducted in the Bronx, NY by Einat B. et al. in a group of 19 children, where 1 out of three patients with signs of heart disease developed ecstatic expansion of the coronary artery [42]. The pediatric patients mentioned in this study will require dynamic monitoring, taking into account the risk of heart damage in the later stages of KD and the unpredictable development of MIS-C.
Conclusions:
Kawasaki disease in the context of SARS-CoV-2 infection is a new disease in pediatrics; however, knowledge about pathogenic mechanisms, risk factors, and long-term consequences is limited. A multidisciplinary approach is essential for early detection of this nosology and the initiation of correct treatment to prevent long-term complications. It is important to find out if MIS-C in children is a new entity or if SARS-CoV-2 is acting as a new trigger for Kawasaki disease. Further research, as well as case studies from around the world, will help avoid delaying urgent and targeted treatment.
ETHICAL APPROVAL BY ETHICAL COMMITTEE
It is not applicable.
COMPETING INTERESTS
Authors have declared that no competing interests exist.
*These authors contributed equally to this work.
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.
