AUCTORES
Globalize your Research
Research Article
*Corresponding Author: Gitali Bhagawati, Consultant and Head, Dept. of Microbiology and Infection Control, Dharamshila Narayana Super- speciality hospital.
Citation: Gitali Bhagawati, Sania Paul, Rekha Saji Kumar, Anita Bhatia, Mansi, Khusboo. (2023), Multidrug Resistant Fungal Isolates from Blood and Urine Samples in Covid-19 Infected Admitted Patients During the Second Wave of Pandemic in India. J, Clinical Case Reports and Studies, 4(4); DOI:10.31579/2690-8808/167
Copyright: © 2023 Gitali Bhagawati, 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: 02 February 2023 | Accepted: 10 February 2023 | Published: 20 March 2023
Keywords: coronavirus disease; Covid-19; urinary tract infections
Background: The coronavirus disease 2019 (COVID-19) pandemic engulfed the whole world with far-reaching consequences on overall health across the globe. In India, second wave of Covid-19 was more devastating; bacterial and fungal co-infections were mostly undiagnosed or under reported due to the constant focus on the virus. Our study was to identify the cases of multidrug resistant fungus in blood and urine in Covid-19 infected patients.
Material and Methods: The retrospective study was carried out during the second wave of Covid-19 pandemic in India in the department of microbiology in a 200 bedded tertiary care hospital in Delhi, over a period of two months- April, and May 2021. Truenat Real Time PCR (Molbio diagnostics Pvt., Ltd., Goa, India) was used for confirming the cases of Covid-19 from nasopharyngeal samples. All blood samples for culture were processed in automated blood culture machine (BACTEC FX40, Becton Dickinson, Heidelberg, Germany). For fungal culture, paired tubes of Sabouraud’s Dextrose Agar (SDA) were used. Vitek 2 Compact System 8.01 (bioMérieux, Inc. Durham, North Carolina/USA) was used for the final identification of yeast and yeast like fungus (YYLF) and their antifungal susceptibility pattern (AFSP). Control strains included Candida albicans ATCC (American Type Culture Collection) 14053, Candida parapsilosis ATCC 22019 etc.
Results: During the 2nd wave of pandemic in India, out of total patients undergone testing by Truenat RT-PCR, Confirmed Covid-19 infection (CCI) was found to be 53.09%. Out of this, patients admitted with Severe Covid-19 infection (SCI) was 22.96%. Blood culture positivity rate among admitted cases were 6.72% (54/803); out of this fungemia was seen in 16.67% (9/54). The prevalence of UTI among Covid-19 infected patients was found to be 18.09% (150/829); YYLF relate UTI was seen in 32% (48/150) patients. Fungal urosepsis (FUS) was found in seven cases of Covid-19 infections; causative agents included C. auris 71.43% (5/7), C. albicans 14.28% (1/7) and T. asahii 14.28% (1/7). All the patients with FUS with SCI had history of prolonged intensive care unit (ICU) stay (>10days) with comorbid condition like diabetes mellitus (DM) (57.14%) and hypertension (HTN) (57.14%). All of them (100%) were catheterized and were on central lines. Out of the 7 patients, 5 (71.43%) were on mechanical ventilator. C. auris isolates were 100% resistant to fluconazole (Minimum inhibitory concentration, MIC >32 mg/L) and voriconazole (MIC >1 mg/L); however, 100% sensitive to caspofungin (MIC 0.25) and micafungin (MIC <0.06).
Conclusion: Elderly patients with high risk factors and associated comorbidity were mostly succumbed to MDR YYLF infections along with Covid-19 infection; many leading to urosepsis with high mortality rate. Covid-19 virus itself and its management were favourable conditions for IFI. Therefore, looking at the drug resistance, prompt diagnosis and treatment are imperative with respect to secondary infections.
The coronavirus disease 2019 (COVID-19) or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic engulfed the nations of the world with far-reaching consequences on overall health across the globe. In India, 29.27 million cases had been reported during the pandemic, with a case fatality rate of 1.24% (363,079 deaths) up to June 11, 2021[1, 2]. India was in the grips of devastating second wave of the virus with repeat lock downs in the country. By mid-April, the country was averaging more than 100,000 cases a day. During the second wave, India's healthcare system has been overburdened, causing a dearth of medical oxygen, hospital beds, and other essentialities for the COVID-19 patients [3].
Although COVID-19 was associated with predominantly respiratory symptoms, many literatures suggest multi-organ involvement such as cardiovascular, lower urinary tract etc. [4, 5]. Historically, super-infections have always been associated with poor outcome during viral illnesses [6, 7]. There are various publications suggestive of both bacterial and fungal co-infections and superinfections in Covid-19 infected patients leading to higher mortality rate [8, 9, 10, 11, 12, 13].
Fungal co-infections in COVID-19 patients emerged with higher incidence of acute infections despite anti-fungal treatment. The emergence of multidrug-resistant (MDR) Candida made the situation worse with treatment failure, adverse clinical outcomes, and even disease outbreaks over the pandemic [15,16]. Candida auris became the global health threat during Covid-19 pandemic because of its notorious ability for colonization in skin and in the environment leading to severe disease with high mortality rates [17].
The objective of our study is to evaluate superadded blood stream infection (BSI) and urinary tract infections (UTI) amongst the admitted patients of Covid-19 infection with special reference to MDR fungal infections.
Study Design
The retrospective study was carried out during the second wave of Covid-19 pandemic in India in the department of microbiology in a 200 bedded tertiary care hospital in Delhi, over a period of two months- April, and May 2021. The overall patients’ data were collected from Laboratory Information System (LIS), requisition forms, WHONET 5.6 software and files from the department of Medical Records Department (MRD). Data analysis included patient profile, medical history, laboratory parameters, microbiological findings, concomitant antimicrobial drug use, and treatments.
Inclusion criteria for the study:
Microbiological testing:
Patients admitted with acute respiratory illness (ARI) were included in the study. Nasopharyngeal samples were taken from admitted patients and confirmed for Covid-19 by Truenat real time PCR method.). Samples taken using nylon swab were inserted into the Viral Transport Medium (VTM) provided from the same company (Molbio diagnostics Pvt., Ltd., Goa, India). Samples were transported immediately and processed in in-house molecular laboratory as per manufacturer’s guideline. (Truenat Beta CoV Chip-based RT-PCR test for Beta Coronavirus, Molbio diagnostics Pvt., Ltd., Goa, India). The target sequence for this assay is E gene of Sarbecovirus and human RNaseP (serves as internal positive control). Confirmatory gene used was RdRP gene or ORF1a gene.
Definition:
Blood for cultures were processed by automated blood culture machine (BACTEC FX40, Becton Dickinson, Heidelberg, Germany). Once the machine flagged positive, we performed Gram stain from the positive blood culture bottle. Based on Gram staining, sub-culture was done in Blood agar (BA), MacConkey agar (MA) and/or Sabouraud’s Dextrose Agar (SDA). BA and MA plates were incubated at 370C for 24 hours for growth. Growth is analyzed for colony morphology and further processed for automated identification and antimicrobial susceptibility (AST) pattern. All plates with no growth were further re-incubated at 370 C for 24 hours. SDA tubes were incubated at both 370 C and 250 C for 24-72hours.
(i) Inclusion criteria:[20]
(a)Positive Paired blood culture
(b)Same species in paired samples,
(c)Single blood culture with significant pathogen.
(ii) Exclusion criteria:
All the urine samples were inoculated on Cystine Lactose Electrolyte Deficient (CLED) agar. For YYLF, based on significant colony count, Gram stain and cultural morphology, colonies were inoculated on two Sabouraud’s Dextrose Agar (SDA) slants, one was incubated at room temperature whereas, other was kept at 37°C for 24 - 72 hrs.
Inclusion criteria:
(a) Non-duplicate urine sample,
(b) Wet mount showing ≥ 10 White blood cells (WBC)/cubic mm,
(c) Significant growth with colony count ≥ 100,000 Colony Forming Unit (CFU)/ml [20]
(d) Colony count with < 100>
Exclusion criteria:
The growth on the slope was processed for identification of the fungus. To differentiate between Candida albicans and Non-albicans Candida (NAC), germ tube test was done.
Usually Yeast and yeast like fungus (YYLF) grows within 24-72hours; which were analyzed for colony morphology. Gram stain and/ Lactophenol cotton blue (LPCB) were carried out to see the structure and arrangement under microscope. Vitek 2 Compact System 8.01 (bioMérieux, Inc. Durham, North Carolina/USA) was used for the final identification and AFST. Control strains for YYLF included Candida albicans ATCC (American Type Culture Collection) 14053, Candida parapsilosis ATCC 22019 and Candida krusei ATCC 14243. MIC of Fluconazole, Voriconazole, 5-flucytosine, Amphotericin B, Micafungin, Caspofungin were standardized as per CLSI guidelines (2017) [22].
Covid-19 positivity rate during peak of 2nd wave in India (April and May 2021):
Total non-duplicate samples received for molecular confirmation of Covid-19 during the peak of 2nd wave of Covid-19 pandemic were 2679 and 1316 in April and May 2021 respectively. CCI in April and May were 62.71% (1680/ 2679) and 33.5% (441/1316) respectively; overall CCI being 53.09 %.
Patients with SCI were admitted during the 2nd wave of Covid-19 pandemic in India. Patients admitted with CCI with SCI were 350 (20.8%) and 137 (31%) in April and May 2021 respectively; overall admitted cases being 22.96%.
Results of blood cultures in patients with CCI:
Total number of non-duplicate blood samples received were 1147. Out of these samples, 344 were paired blood culture sets, from 344 patients; 459 were single blood cultures with significant growth with corresponding clinical history. The total number of patients undergone blood culture were 803.
Overall, blood culture positivity rate was 12.45% (100/803). Out of these, Coagulase negative Staphylococcus (CONS) comprised of 7% (56/803). On clinical correlation, CONS were found to be contaminants in 46 cases (5.73%). So, excluding contaminants, the positivity rate of blood culture was 6.72% (54/803).
Out of all pathogenic bacterial and fungal isolates in blood culture comprised of 83.33% (45/54) and 16.67% (9/54) respectively. The causative agent of fungemia was -C. auris 77.77% (7/9); rest were C. albicans 11.11% (1/9) and T. asahii 11.11% (1/9)
Figure 1: Causative agents of Fungemia in patients with CCI
Results of urine cultures in patients with CCI:
Total number of non-duplicate urine samples received during the peak of 2nd wave were 829. The prevalence of UTI among Covid-19 infected patients was found to be 18.09% (150/829). Prevalence of UTI by YYLF was found to be 32% (48/150). Growth with double isolates were 11 (7.33%), while the rest 139 (92.66%) had single isolate. Out of all fungal isolates, the predominating one was C. auris, 35.42% (17/48) followed by Trichosporon asahii, 25% (12/48).
Figure 2: Causative agents of Yeast and Yeast like fungus in patients with CCI
Common isolates in Blood and Urine in patients with CCI:
Out of total 487 admitted cases, 16 (3.28%) patients had common isolates in both blood and urine samples.
Out of these, samples with common fungal and bacterial isolates were 56% (9/16) and 44% (7/16) respectively. The predominant fungus causing common infections include C. auris 78% (7/9).
Out of total nine cases with common causative organisms for BSI and UTI, seven had line related UTI prior to BSI which can be labelled as fungal urosepsis (FUS). Causative agents of FUS include C. auris 71.43% (5/7), C. albicans 14.28% (1/7) and T. asahii 14.28% (1/7).
Figure 3: Causative agents of fungal urosepsis in patients with SIC
Demographic profile of CCI with urosepsis:
Out of seven cases, six (85.71%) belonged to elderly age group >=60 years with male to female ratio 5:2. All the patients with FUS with SCI with history of prolonged intensive care unit (ICU) stay (>10 days) with comorbid condition like diabetes mellitus (DM) (57.14%) and hypertension (HTN) (57.14%). All of them (100%) were catheterized and were on central lines. Out of the 7 patients, 5 (71.43%) were on mechanical ventilator. All the seven patients were given prolonged broad-spectrum antibiotics, steroids and immunomodulators. The mortality rate, 71.43% (5/7) was high among these patients.
Table 1: Demographic profile of patients with SIC with FUS
Table 2: Laboratory parameters of patients with SIC with FUS
Note: Covid markers (serum ferritin, CRP, D. Dimer, LDH, Alkaline phosphatase) were elevated in all the patients.
Antifungal susceptibility pattern (AFSP) of Fungal isolates:
C. auris isolates were 100% resistant to fluconazole (Minimum inhibitory concentration, MIC >32 mg/L) and voriconazole (MIC >1 mg/L); however, 100% sensitive to caspofungin (MIC 0.25) and micafungin (MIC <0>T. asahii was susceptible Amp B and C.albicans was sensitive to all antifungals.
Table 3: MICs Antifungals for YYLF causing urosepsis in patients with SIC
SARS- CoV positive patients had 20
Secondary BSIs and UTIs were quite common in SARS-Cov-2 infected patients. Prevalence of coinfections and superinfections were negligible in literatures in the early part of the pandemic. This may be because of the scare associated with the disease, burden on human resource in health care, improper guideline to process secondary infections apart from Covid-19 itself, drawbacks of donning of PPE for prolonged period etc. Elderly patients with high risk factors and associated comorbidity were mostly succumbed to MDR YYLF infections; many leading to urosepsis with high mortality rate. Covid-19 virus itself and its management were favourable conditions for IFI. Therefore, prompt diagnosis and treatment are imperative with respect to secondary infections. Diagnostic stewardship associated with antibiotic stewardship along with proper infection measures are the tools to decolonize the MDR YYLFs in health care.
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.
