AUCTORES
Globalize your Research
Research Article
*Corresponding Author: Jose Luis Turabian, Specialist in Family and Community Medicine Health Center Santa Maria de Benquerencia. Regional Health Service of Castilla-la Mancha (SESCAM), Toledo, Spain.
Citation: Jose L. Turabian (2024), Case Series of Covid-19 Infections with Fourth Dose of Bivalent Mrna Vaccine in The Period from October 2022 to October 2023 in A General Medicine Office of Toledo (Spain), Clinical Research and Clinical Trials, 9(1); DOI:10.31579/2693-4779/170
Copyright: © 2024, Jose Luis Turabian. 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: 22 November 2023 | Accepted: 14 December 2023 | Published: 08 January 2024
Keywords: covid-19; sars-cov-2; epidemiological characteristic; symptoms; case series; general practice
Background
The effectiveness of administering booster doses with vaccines adapted to new variants and subvariants is still a matter of debate.
Objective
To describe the cases of covid-19 infections in vaccinated people with 4th dose.
Methodology
An observational, longitudinal and prospective case series study of adult patients with covid-19 infections in vaccinated people with 4th dose in general medicine from October 1, 2022 to October 1, 2023. Descriptive epidemiological analysis considered a set of selected demographic and clinical features.
Results
21 covid-19 infections were included in vaccinated people with 4th dose from October 2022 October 2023. The main characteristics were: 67% > = 65 years, 62% women, 24% Socio-Health Care Workers, 9% with Moderate-severe severity (hypoxia, pneumonia), 86% had Chronic diseases [mainly Circulatory system (22%) and Endocrine (20%)]. There were practically no psychosocial risk factors [Complex family/ Problems in the family context, Low-income household, Ethnic minority (5, 0% and 0% respectively)], and 24% were re-infections. General symptoms (discomfort, asthenia, myalgia, fever, arthralgia) (42%) and Respiratory symptoms (cough, dyspnea, chest pain) (31%) predominated.
Conclusion
In our series from October 2022 October 2023, in the context of a general medicine consultation in Toledo (Spain), the risk profile of the cases, the frequency of reinfections and the infrequency of severity, suggests that revaccination is still advisable in vulnerable people such as older people, women, socio-health care workers and chronically ill people.
Since March 2020, when the World Health Organization declared the state of pandemic for the coronavirus disease 2019 (covid-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), it has evolved in several periods of different duration and repercussions in terms of morbidity and mortality (1). One of the determinants of morbidity and mortality has been the behavior of the virus during the pandemic from the original strain (Wuhan-alpha) to the currently predominant Omicron. Said behavior of the virus, in addition to the health measures implemented, especially vaccination, explain the differences between the pandemic and currently endemic period with respect to symptomatic infection, morbidity and deaths (2-4).
Currently, the predominant variant in Spain is Omicron, which has a greater immune escape capacity than previous variants, is more transmissible and has less severity. It comprises five lineages-mutations: BA.1, BA.2, BA.3, BA.4 and BA.5. So far, no differences in the severity of the cases have been observed for any of them. Currently, the BA.5 variant is the dominant one (5). In Spain, from the beginning of vaccination until September 14, 2022, 93% of citizens over 12 years of age had the complete vaccination schedule (6). The Health Authorities decided to start vaccinating the fourth dose to people over 80 years of age and institutionalized with a bivalent vaccine available. Depending on the availability of vaccines, it was extended to people over 60 years of age, immunosuppressed people, social health workers and pregnant women, and finally rest of population (7).
The previous monovalent boosters had managed to recover vaccine effectiveness up to 85-90% against hospitalization and death, which had decreased over the months and coinciding with the circulation of the Omicron variant and its immune evasion (8). For the second booster (fourth dose) bivalent vaccines were used (9). Since September 1, 2022, the European Commission and the European Medicines Agency (EMA) authorized the use of the adapted covid-19 vaccines Comirnaty Original/Omicron BA.1 and Spikevax bivalent Original/Omicron BA.1, as vaccines for a second booster dose in people over 12 years of age with the complete primary vaccination schedule and at least 3 months after the last dose of vaccine administered. Likewise, the EMA approved the adapted bivalent covid-19 vaccine Comirnaty Original/Omicron BA.4- BA.5 for use in people over 12 years of age who have received at least one primary cycle of vaccination against coviod-19 (10, 11).
With the adaptation of vaccines, the aim was to expand protection against different variants. Predictive studies of the efficacy of bivalent boosters in the vaccinated population concluded that protection against serious infection rose from 50% to 87% with monovalent booster, while it would reach 98% when using bivalent booster. Furthermore, the lower the preboost immunity, the greater the relative benefit of a bivalent booster would be (12). Its approval was based on clinical data available with Comirnaty Original/Omicron BA.1 and laboratory immunogenicity studies. Studies showed that the bivalent vaccine can trigger strong immune responses against Omicron BA.1 and the original SARS-CoV-2 strain in previously vaccinated people, and greater responses against subvariant BA.1 than the original vaccines (13).
However, applying a fourth dose in general population has the disadvantages that it can lead to low vaccine coverage due to pandemic fatigue, and that repetition with new doses can cause a phenomenon of immune tolerance. A repeat dose of the bivalent BA.5 mRNA vaccine, as recommended for some populations, may not be sufficient to broaden neutralizing antibody responses and overcome immunological imprinting in elderly but healthy individuals (14).
In this changing scenario, where clinical studies are still ongoing, and where epidemiological surveillance has been greatly reduced, causing a lack of data regarding many population groups (2, 15, 16), sustained clinical-epidemiological surveillance are needed, which could include longitudinal cohort studies. In this context, we present an observational, longitudinal and prospective case series study of adult patients with covid-19 infections in vaccinated people with 4th dose in general medicine from October 1, 2022 to October 1, 2023.
Design and emplacement
An observational, longitudinal and prospective study of Covid-19 infections in vaccinated people with 4th dose was conducted from October 1, 2022 to October 1, 2023, in a general medicine office in Toledo, Spain, which has a list of 2,000 patients> 14 years of age (in Spain, the general practitioners [GPs] care for people > 14 years of age, except for exceptions requested by the child's family and accepted by the GP). The GPs in Spain work within the National Health System, which is public in nature, and are the gateway for all patients to the system, and each person is assigned a GP (17). Data from this series of cases were previously published from a shorter period of time than that of the current study, and global data on all covid infections in people with and without a fourth dose of vaccination (18-20).
Outcome of interest
To describe the cases of covid-19 infections in vaccinated people with 4th dose.
Diagnosis of covid-19
The diagnosis was performed with reverse transcriptase polymerase chain reaction oropharyngeal swab tests or antigen testing (21) performed in health services or at home.
Collected variables
The following variables were collected:
-Age and sex
-Chronic diseases (defined as "any alteration or deviation from normal that has one or more of the following characteristics: is permanent, leaves residual impairment, is caused by a non-reversible pathological alteration, requires special training of the patient for rehabilitation, and / or can be expected to require a long period of control, observation or treatment” (22), classified according to the International Statistical Classification of Diseases and Health-Related Problems, CD-10 Version: 2019 (23)
-If they were Health Care Workers
-Problems in the family context and low-income household based on the genogram and in the experience of the GP for their continuity of care and knowledge of the family (genogram is a schematic model of the structure and processes of a family, which included the family structure, life cycle and family relational patterns. It was understood that "complex" genograms present families with psychosocial problems) (24, 25)
-Ethnic minority (defined as a “human group with cultural, linguistic, racial values and geographical origin, numerically inferior compared to the majority group”) (26)
-Disease severity (classified according to: 1. mild cases: clinical symptoms are mild and no manifestation of pneumonia can be found on images; 2. moderate cases: with symptoms such as fever and respiratory tract symptoms and the manifestation of pneumonia can be seen on the imaging tests; and 3. severe cases: respiratory distress, respiratory rate ≥ 30 breaths / min., pulse oxygen saturation ≤ 93% with room air at rest, arterial partial pressure of oxygen / oxygen concentration ≤ 300 mmHg.) (27); to simplify comparison, moderate and severe cases were counted together;
-Date of covid-19 infection diagnosis
-Presence of reinfection (SARS-CoV-2 reinfection was conventionally defined as a documented infection occurring at least 90 days after a previous infection) (28, 29)
-Vaccination status against covid-19 at the date of acute infection: vaccinated with fourth dose (second booster) for fall-winter 2022 (30)
Epidemiological analysis
Descriptive epidemiological analysis considered a set of selected demographic and clinical features. Excessive fragmentation of the data was avoided to avoid showing a small number of cases. The age of 65 years was used as the beginning of old age (31)
Ethical issues
No personal data of the patients were used, but only group results, which were taken from the clinical history.
21 covid-19 infections were included in vaccinated people with 4th dose from October 2022 October 2023. The main characteristics were: 67% > = 65 years, 62% women, 24% Socio-Health Care Workers, 9% with Moderate-severe severity (hypoxia, pneumonia), 86% had Chronic diseases [mainly Circulatory system (22%) and Endocrine (20%)]. There were practically no psychosocial risk factors [Complex family/ Problems in the family context, Low-income household, Ethnic minority (5, 0% and 0% respectively)], and 24% were re-infections. General symptoms (discomfort, asthenia, myalgia, fever, arthralgia) (42%) and Respiratory symptoms (cough, dyspnea, chest pain) (31%) predominated (TABLE 1, TABLE 2, TABLE 3).
| VARIABLES | COVID-19 INFECTIONS IN VACCINATED PEOPLE WITH 4TH DOSE FROM OCTOBER 2022 OCTOBER 2023 N= 21 |
| > = 65 years | 14 (67) |
| = < 45> | 0 |
| Women | 13 (62) |
| Social-occupancy class of patients (people with some type of labor specialization) | 7 (33) |
| Socio-Health Care Workers | 5 (24) |
| Moderate-severe severity | 2 (9) (hypoxia, pneumonia) |
| Chronic diseases | 18 (86) |
| Complex family/ Problems in the family context | 2 (9) |
| Low income household | 0 |
| Ethnic minority | 0 |
| Reinfection | 5 (24) |
(): Denotes percentages
Table 1: Selected Variables Of Covid-19 Infections In Vaccinated People With 4th Dose From October 2022 October 2023
SYMPTOMS COVID-19 INFECTION* ACCORDING TO WHO, ICD-10 GROUPS | COVID-19 INFECTIONS IN VACCINATED PEOPLE WITH 4TH DOSE FROM OCTOBER 2022 OCTOBER 2023 N= 21 |
| General (discomfort, asthenia, myalgia, fever, artralgias) | 30 (42) |
| Respiratory (cough, dyspnea, chest pain) | 22 (31) |
| ENT (anosmia / ageusia, odynophagia, rhinorrhea, pharyngeal dryness-mucus, epixtasis, ear pain) | 11 (15) |
| Digestive (anorexia, nausea / vomiting, diarrhea, abdominal pain) | 1 (1) |
| Neurological (headache, dizziness, mental confusion, dysarthria, disorientation, photopsia, syncope) | 7 (10) |
| Psychiatric (aAnxiety, insomnia) | 0 |
| Skin (chilblains, flictenas, rash) | 0 |
| Urológico (dysuria, frequency) | 1 (1) |
| Total, symptoms* | 72 (100) |
(): Denotes percentages; * Patients could have more than one symptom. The percentages are over the total of symptoms
Table 2: Symptoms of Covid-19 Infections In Vaccinated People With 4th Dose From October 2022 To October 2023
CHRONIC DISEASES* ACCORDING TO WHO, ICD-10 GROUPS | COVID-19 INFECTIONS IN VACCINATED PEOPLE WITH 4TH DOSE FROM OCTOBER 2022 OCTOBER 2023 N= 21 |
| -I Infectious | 0 |
| -II Neoplasms | 2 (3) |
| -III Diseases of the blood | 3 (4) |
| -IV Endocrine | 14 (20) |
| -V M/ental | 9 (13) |
| -VI-VIII Nervous and Senses | 5 (7) |
| -IX Circulatory system | 16 (22) |
| -X Respiratory system | 2 (3) |
| -XI Digestive system | 7 (10) |
| -XII Diseases of the skin | 2 (3) |
| -XIII Musculo-skeletal | 5 (7) |
| -XIV Genitourinary | 6 (8) |
| TOTAL, chronic diseases* | 71 (100) |
(): Denotes percentages; *Patients could have more than one chronic disease. The percentages of chronic diseases are over the total of chronic diseases
Table 3: Chronic Diseases In Covid-19 Infections In Vaccinated People With 4th Dose In The Period From October 2022 To October 2023
. Main findings
The main results of our study were that the covid-19 infections in vaccinated people with 4th dose:
1. They predominated in people over 65 years of age, women, with chronic diseases of the Circulatory system and Endocrine, without psychosocial risk factors, and with a significant frequency in Socio-Health Care Workers.
2. The main symptoms were General (discomfort, asthenia, myalgia, fever, arthralgia) and Respiratory (cough, dyspnea, chest pain).
3. They mostly presented mild severity.
4. A quarter of these infections were re-infections.
From the first months of 2022, the Omicron variant was the dominant variant in Spain after having displaced the Delta variant (32). The predominant variants in Spain during 2023 were those of the XBB family. The XBB.1.5 lineage became dominant globally in February 2023 and in March in Spain. The “Eris” variant (EG.5), a descendant of the omicron, also of the XBB family, has spread rapidly since the end of July 2023 throughout the United States, Europe (including Spain) and Asia (5, 33-36).
On the other hand, covid-19 is at a tipping point, meaning that high levels of immunity to SARS-CoV-2 are beginning to limit its impact and reach. Currently, many countries do not test all symptomatic patients, nor do they systematically collect the number of cases or their clinical-epidemiological characteristics (16, 37). In Spain, the surveillance and control strategy against covid-19 after the acute phase of the pandemic, in force since March 28, 2022, indicates the need to perform PCR or antigen testing only in specific situations that fundamentally include people with vulnerability criteria, of vulnerable areas, and those that require hospital admission. The reported cases therefore represent these groups and not the total number of SARS-CoV-2 infections, so the evolution of the pandemic monitoring indicators must be adapted to this circumstance and the data from these reports cannot be compared with those of prior reports (38). In this situation, many people with symptoms in the community choose to perform individual tests at home (39). But, frequently, people with a positive test at home do communicate this circumstance to their family doctor, to seek treatment and/or sick leave.
Taking into account these circumstances that contextualize our results, given the risk profile of the cases and the frequency of reinfections, and the infrequent severity of the infections, one can think about the usefulness of the fourth dose of vaccine; as well as the in its short duration. So, it would seem reasonable to continue advising revaccination of vulnerable people (the elderly, women, Health Care Workers and chronically ill patients).
2. Comparison with other studies
Vaccination provides substantial protection against both symptomatic and severe covid-19. However, there has been continued and substantial evolution of SARS-CoV-2 variants since the virus emerged, such as Omicron and its sub-variants, posing challenges for the public health response, including ensuring that vaccines continue to provide protection, which have markedly reduced efficacy in regimens based on the ancestral Wuhan variant. Thus, booster vaccination for the prevention of covid-19 is required to overcome this loss of protection (40, 41).
Since September 2022, Moderna and Pfizer-BioNTech bivalent SARS-CoV-2 vaccines containing equal amounts of spiked mRNA from the ancestral BA.4-BA.5 and omicron subvariants replaced their monovalent counterparts as booster doses for people over 12 years old. It is strongly suggested that a bivalent booster may preserve the safety and serological efficacy of the original monovalent booster while broadening the spectrum of antibody response, helping to restore protection that might have diminished since the last previous dose (42-49). This justifies the use of sequence-adapted vaccines (50-60). Thus, it has been reported that benefits of mRNA covid-19 vaccines in protecting against the omicron variant outweigh the risks, regardless of age, sex, and comorbidity (61).
Immunological profiles are increasingly heterogeneous (individuals who have been previously infected, or previously vaccinated with a primary series and/or booster doses on different platforms, with various spike protein antigens; as well as individuals who have been infected and then vaccinated, and individuals who have been vaccinated and then infected), so the performance of an updated vaccine will vary depending on the nature and magnitude of the previously acquired immunity in each person (40). The continued circulation of SARS-CoV-2 in the current endemic period will manifest itself depending on reinfection rates, the availability and effectiveness of the vaccine, and the social, immune and innate factors that modulate the transmissibility of the virus (62). We found 24% of covid-19 re-infections were in vaccinated people with 4th dose.
Bivalent vaccine, a previous infection, or timely access to screening and treatment can help prevent the seriously cases from Covid-19. However, some people are more likely than others to become seriously ill from Covid-19. This includes older people or those who are immunocompromised, certain disabilities or underlying conditions (57, 60, 63, 64). We found that 67% of the covid-19 cases with the fourth dose of vaccine were >= 65 years, and 86% had chronic diseases, mainly of the Circulatory system (22%) and Endocrine (20%).
Finally, in relation to psychosocial factors, understood as the risks to physical, mental, mental and social health generated by socioeconomic determinants, the employment condition, the organization and content of work and the relational factors that intervene in the psychological functioning, it is admitted that they influence cognitive, emotional, behavioral processes and, with regard to risk perception of covid-19 and vaccination with the fourth dose (65). In our study we did not find psychosocial risk factors in cases of covid-19 with the fourth dose.
1. The number of cases was small and thus the results may be subject to erroneous interpretations.
2. Asymptomatic patients were not included, since no screening intervention was performed
3. The great accessibility of patients to the family doctor, and the fact of the continuity of care that characterizes family medicine, suggest that the data presented correspond to the population reality.
4. It must be taken into account that case series studies only include "numerators" so they cannot be extrapolated to incidence rate values.
In our series from October 2022 October 2023, in the context of a general medicine consultation in Toledo (Spain), covid-19 infections in vaccinated people with 4th dose predominated in older women with chronic diseases of the Circulatory system and Endocrine; without psychosocial risk; with a significant frequency in Socio-Health Care Workers; with General symptoms (discomfort, asthenia, myalgia, fever, arthralgia) and Respiratory symptoms (cough, dyspnea, chest pain), with slight severity; and a quarter of these infections were re-infections. Given the risk profile of the cases, the frequency of reinfections, and the low frequency of severity, revaccination of vulnerable people (the elderly, women, Health Care Workers and chronically ill people) is still advisable.
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.
