Role of Mri in Characterization of Congenital Malformations of Brain in A Tertiary Care Centre-A Retrospective Study

Research Article

Role of Mri in Characterization of Congenital Malformations of Brain in A Tertiary Care Centre-A Retrospective Study

  • Arup Maity 1
  • Debashis Dakshit 2
  • Debarpita Datta 3*

*Corresponding Author: Debarpita Datta, Professor, Senior resident, Department of Radiodiagnosis, R.G Kar Medical College and Hospital.

Citation: Arup Maity, Debashis Dakshit, Debarpita Datta, (2024), Role of Mri in Characterization of Congenital Malformations of Brain in A Tertiary Care Centre-A Retrospective Study, J. Endocrinology and Disorders, 8(3): DOI:10.31579/2640-1045/183

Copyright: © 2024, Debarpita Datta. 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: 12 April 2024 | Accepted: 26 April 2024 | Published: 10 May 2024

Keywords: obesity; dopamine; insulin; food behavior; reward; leptin; ghrelin; african american; black; afro-american

Abstract

Background: Congenital brain anomalies are rare among the congenital anomalies of various organ systems. It is crucial to recognise these disorders as soon as possible because of the extensive neurological deficiency and negative consequences they can cause. Neuroimaging is a reliable way to accurately diagnose the majority of congenital brain abnormalities. There aren't enough statistics available in developing countries like India about the frequency and types of brain abnormalities. The purpose of this study is to examine the prevalence and range of frequently occurring congenital brain abnormalities.

Objective: To study the whole spectrum of all substantial and frequently occurring congenital abnormalities as well as the proportional distribution of the various brain malformations in a tertiary care centre.

Methods and materials: The study was conducted at Department of Radio-Diagnosis, Medical College Kolkata from 1st September 2022 to 31st August 2023. All MRI brain examinations at our hospital over a period of one year were retrospectively reviewed and analysed by sex, age at presentation, type of congenital cerebral malformation, and other associated congenital cerebral malformations.

Results: This study included 24 patients. The total number of brain malformations identified in these patients was 33. The age of patients at first MRI imaging ranged from 5 days to 16 years. There were 14 males and 10 females. The most common malformations were corpus callosum dysgenesis (24%), Heterotropia (15%) and Lissencephaly (12%). Seven patients (29.1%) had more than one congenital brain malformation.

Conclusion: The variety and complexity of congenital brain abnormalities is remarkable. The correct diagnosis is essential for the best care of these unfortunate conditions, and MRI plays a significant role in this process. Identification of distinctive neuroimaging findings of various congenital brain anomalies are immensely helpful in diagnosing the anomalies and further management.

Introduction

Congenital brain anomalies are rare among the congenital anomalies of various organ systems. There are more than 2000 different forms of congenital malformations (CM) of the brain that have been described in the literature. Congenital deformities have a wide range of etiologic causes, which can be broadly categorised into genetic, environmental, exposure to teratogens, and specific deficiencies, including folate and iodine, with some studies attributing a multifactorial origin. Known risk factors for congenital abnormalities include maternal age, drug usage, teratogen exposure, radiation exposure, maternal diseases, smoking, and alcohol consumption. Congenital brain malformations have been diagnosed using a variety of imaging modalities, including computed tomography (CT), MRI, and ultrasound. MRI is the modality of choice because it is not only perfect, especially for young patients, but also because it is multiplanar and multiaxial, has great soft-tissue delineation, and has no known biohazard effects. There aren't enough statistics available in developing countries like India about the frequency and types of brain abnormalities. The purpose of this study is to examine the prevalence and range of frequently occurring congenital brain abnormalities.

Congenital brain anomalies can be classified as: 

  1. Disorders of primary neurulation: These are mostly neural tube closure defects and early CNS anomalies occurring during 3rd and 4th gestational weeks. These include Chiari malformations, cephaloceles and myelomeningoceles.
  2. Disorders of diverticulation, cleavage, sulcation and cellular migration. These include:
    1. Holoprosencephaly
    2. Lissencephaly
    3. Cortical dysplasia
    4. Heterotropia
    5. Schizencephaly.
  3. Posterior fossa malformations include:
    1. Dandy-Walker malformations
    2. Joubert syndrome
    3. Rhombencephalosynapsis.

Disorder of histiogenesis

Materials and Methods

Patients:

The study was conducted at Department of Radio-Diagnosis, Medical College Kolkata. All MRI brain examinations at our hospital over a period of one year were retrospectively reviewed and analysed by sex, age at presentation, type of congenital cerebral malformation, and other associated congenital cerebral malformations. The study was conducted from 1st September 2022 to 31st August 2023.

Inclusion and exclusion criteria:

All paediatric patients (<18>

Imaging technique:

In our institution, all brain MRI scans were performed in accordance with the standard protocols and positioning for brain MRI. The patients were lying supine on the MRI table with the median sagittal plane equally spaced from the table edges. An orthogonal 3-plane localizer was then obtained, consisting of axial, sagittal, and coronal views. Sagittal images were obtained on a coronal or axial localizer image. The corpus callosum, the Sylvian aqueduct, the fourth ventricle, and the cervical spinal cord were used as landmarks to identify the midsagittal plan. Axial images were obtained on a sagittal localizer and were positioned parallel to the bicommissural line or parallel to a line linking the floor of the sella turcica to the fastigium of the fourth ventricle. Coronal images were obtained on a sagittal localizer positioned parallel to the posterior surface of the brainstem.

Imaging Sequences:

•               T1-weighted sequences

•               T2-weighted sequences

•               Fluid-attenuated inversion recovery sequences 

•               Diffusion weighted sequences

•               Gradient echo sequences

A slice thickness of 4 mm with 1 mm was used for all sequences done at our institute. Flip angles of 90° and 180° were used for T1- and T2-weighted sequences, respectively.

Image analysis:

The interhemispheric fissure, cerebral cortex, ventricles, white matter, basal ganglia, internal and external capsule, corpus callosum, brain stem, cerebellum, intracranial vessels, pituitary and sella, petrous pyramids, paranasal sinuses, and orbit were evaluated for size, shape, position, signal characteristics, and potential space-occupying lesions.

Ethical Consideration:

The study was conducted after getting approval from Institutional Ethics Committee and other authority. 

Results

This study included 24 patients. The total number of brain malformations identified in these patients was 33. The age of patients at first MRI imaging ranged from 5 days to 16 years. There were 14 males and 10 females. 


 

Age(years)No.%
<1>729.2
1-101145.8
10-20625
Min-Max5d-16 yrs.
Mean+- SD6 +-1.2
Median7
    

                

 

 

 

 

 

 

 

Table 1: Distribution of patients according to age.

Figure 1: Distribution of patients according to age.

 

SexNo.%
Male1458.3
Female1041.6

 

 

 

 

 

 

Table 2 and Figure 2: Distribution of patients according to sex.

Delayed developmental milestones was the most common presenting symptom in 10(41.6%) of cases, followed by seizures 5(20.8%), macrocephaly 4(16.6%), vomiting 3(12.5%) and mental impairment in 2(8.3%) of cases.

 

SymptomsNo.%
Delayed developmental milestones1041.6
Macrocephaly416.6
   
Seizures520.8
Mental impairment28.3
Vomiting312.5

                

 

                

 

 

 

 

 

Table 3 and Figure 3: Distribution of Patients according to symptoms.

The total number of brain malformations identified in these patients was 33. Seven patients (29.1%) had more than one congenital brain malformation. The most common malformations were corpus callosum dysgenesis (24%), Heterotropia (15%) and Lissencephaly (12%).

 

DiagnosisNo.%
Corpus callosum dysgenesis824
Heterotropia515
Lissencephaly412
Schizencephaly26
Porencephalic cyst13
Pachygyria39
Chiari 2 Malformation26
Dandy walker Spectrum26
Holoprosencephaly26
Arachnoid Cyst39
Aqueductal stenosis13

 

 

 

Table 4 and Figure 4: showing frequency distribution of congenital malformations.

Images

Case 1:

A 1-year-old female showing myelomeningocele and inferior displacement of cerebellar vermis consistent with Chiari 2 Malformation.

Case 2:

 


 

An 18 months old female with developmental delay. Axial T1W and T2W images show marked and diffuse thickening of the cerebral cortex bilaterally with a few poorly formed gyri and a smooth outer surface of both cerebral hemispheres giving figure of 8 appearance consistent with Classic Type 1 Lissencephaly with pachygyria. There is also dilatation of ventricular system.

Case 3:


 

 

A 5-year-old male child with developmental delay. Axial T1W, T2W and Sagittal T2W images show complete absence of corpus callosum, parallel non converging lateral ventricles and colpocephaly consistent with corpus callosum agenesis. 

Case 4:

A 6-month-old female with seizures. Axial T1W, Sagittal and coronal T2W images show a large cystic cavity in right fronto-parieto-temporal lobes communicating with right lateral ventricle consistent with porencephalic cyst.

Case 5:

A 2-year-old female with seizures. Axial T1W and T2W images show open lip schizencephaly, nodular grey matter heterotropia and pachygyria on left side.


 

Discussion

Congenital brain abnormalities are structural or functional defects that develop in utero and can be detected during pregnancy, at birth, or as symptoms and signs later in life. Some are never symptomatic and are later recognised as incidental discoveries. MRI has had an important impact on the study and understanding of congenital cerebral malformations. MRI allows for study of the entire spectrum of such malformations, from mild to severe. Moreover, MRI permits multiple cuts in multiple planes at multiple occasions, providing a better understanding of the temporal evolution of these diseases. Since most brain structures develop at roughly the same time during foetal life, it is common to see multiple anomalies in association. As a result, one case with multiple anomalies may fit into many classes of cerebral malformations.

Embryologically, the brain develops in 4 stages. Stage 1 involves dorsal induction with formation and closure of the neural tube, and this takes place between 3rd and 5th week of embryological life. Failure of this stage results in neural tube defects.  Stage 2 involves ventral induction with formation of the brain segments and face at 5–10 weeks. Failure of this results in holoprosencephaly, Dandy–Walker malformation, and facial anomalies to mention a few. Stage 3 involves migration and histogenesis at 2–5 months of gestation with the failure of migration resulting in heterotopias, agyria-pachygyria, polymicrogyria, schizencephaly, corpus callosal agenesis, while the failure of histogenesis results in aqueductal stenosis, arachnoid cysts, megalencephaly, phakomatoses, congenital vascular malformations, and neoplasms. Cerebral atrophy and hydrocephalus occur at the stage of myelination (Stage 4).

In our study of 24 patients, the total number of brain malformations identified were 33 in number. The age of patients at first MRI imaging ranged from 5 days to 16 years. There were 14(58%) males and 10(42%) females. The most common malformations were corpus callosum dysgenesis (24%), Heterotropia (15%) and Lissencephaly (12%). Seven patients (29.1%) had more than one congenital brain malformation. Neural tube defect was seen only in 2(6%) patients. Cortical migrational defects were found in 9 (27.27%) patients, 5 of whom had lissencephaly and the remaining 4 gray matter heterotopia. Three patients were found to have disorders of cortical organization in the form of pachygyria. In only one of these patients was there also schizencephaly in association with cortical migrational defects (periventricular nodular heterotopia).

In our studies, a predominance of cortical migrational abnormalities and corpus callosum anomalies has been demonstrated and the results are similar to what has been observed in other parts of the world. Although most congenital cerebral malformations followed the usual and commonly described pattern and appearance, some did not. 

Conclusion

The variety and complexity of congenital brain abnormalities is remarkable. The correct diagnosis is essential for the best care of these unfortunate conditions, and MRI plays a significant role in this process. MRI plays a significant role in delineating these anomalies, with a significant impact on the study and understanding of the malformations and their evolution. Identification of distinctive neuroimaging findings of various congenital brain anomalies are immensely helpful in diagnosing the anomalies and further management. 

References

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.

img

Virginia E. Koenig

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.

img

Delcio G Silva Junior

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.

img

Ziemlé Clément Méda

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.

img

Mina Sherif Soliman Georgy

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.

img

Layla Shojaie

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.

img

Sing-yung Wu

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.

img

Orlando Villarreal

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.

img

Katarzyna Byczkowska

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.

img

Anthony Kodzo-Grey Venyo

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.

img

Pedro Marques Gomes

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.

img

Bernard Terkimbi Utoo

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.

img

Prof Sherif W Mansour

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.

img

Hao Jiang

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.

img

Dr Shiming Tang

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.

img

Raed Mualem

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.

img

Andreas Filippaios

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.

img

Dr Suramya Dhamija

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.

img

Bruno Chauffert

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!

img

Baheci Selen

"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".

img

Jesus Simal-Gandara

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.

img

Douglas Miyazaki

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.

img

Dr Griffith

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.

img

Dr Tong Ming Liu

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.

img

Husain Taha Radhi

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.

img

S Munshi

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.

img

Tania Munoz

“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”.

img

George Varvatsoulias

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.

img

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.

img

Khurram Arshad

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.

img

Gomez Barriga Maria Dolores

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.

img

Lin Shaw Chin

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.

img

Maria Dolores Gomez Barriga

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.

img

Dr Maria Dolores Gomez Barriga

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¨.

img

Dr Maria Regina Penchyna Nieto

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.

img

Dr Marcelo Flavio Gomes Jardim Filho

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!”

img

Zsuzsanna Bene

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

img

Dr Susan Weiner