AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/2578-8949/181
1Department of Medical Laboratory Sciences, Faculty of Health Sciences University of Buea, Buea, Cameroon.
2 Blood Bank, Bafoussam Regional Hospital, Bafoussam, Cameroon.
3Department of Microbiology, Hematology and Immunology, Faculty of Medical and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon.
4Department of microbiology and parasitology, Faculty of sciences, University of Buea, Buea, Cameroon.
5Department of Biochemistry, Faculty of Sciences, University of Dschang, Dschang, Cameroon.
6Faculty of Medicine, Higher institute of Health Sciences, University of Montagnes Bangante, Bangante, Cameroon.
*Corresponding Author: University of Dschang, Department of Biochemistry, P.O.Box 67 Dschang, Cameroon, and Michel Noubom, Department of Microbiology, Haematology and Immunology, Faculty of Health and Pharmaceutical Science, P.O Box 96, University of Dschang.
Citation: Caroline N. Gesu, Michel Noubom, Patrick Njukeng, Leonard F. Sama, Ebaiayuknso Etambe, et al, (2024), Joint effects of risk factors of adverse events associated with blood donations in western region of Cameroon, Dermatology and Dermatitis, 9(8); DOI: 10.31579/2578-8949/181
Copyright: © 2024, Leonard Fonkeng Sama. 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: 15 October 2024 | Accepted: 08 November 2024 | Published: 18 December 2024
Keywords: blood donation; adverse events; vasovagal reactions; site of donation
Objective: To determine the risk factors of adverse events associated with blood donation in western region of Cameroon
Design: Cross sectional study
Setting: This study was carried out at the blood donors service, Regional Hospital West, West Region of Cameroon, from January 2020 to December 2021.
Participants: 252 cases of Donors were of body weight, ≧ 50kg and a hemoglobin (Hb) level of ≧13.0g/dL for males and a body weight of ≧45kg and an Hb level of ≧12.0g/dL for females. Hb screening was based on copper sulfate density. SBP was defined as 90 to160 mmHg and DBP as 50 to 95 mmHg. Pulse rate was between 60 and100 beats per minute.
Methods: The variables, age, BMI, pre-donation SBP, pre-donation DBP, and EBV were dichotomized by their median values. All statistical analyses in this study were performed using GraphPad Prism software version 8.0.2.
Interventions: No intervention was done during the period of study
Outcome measures: Donor records were obtained from participant questionnaire sheet. They included collection donation volume, and number of donations. BMI was calculated.
Results: A total of 252 whole blood donors accepted to participate in this study. The mean age (±SD) of the study population was 29.82 ± 8, 56 years, and the ages ranged from 18 to 61 years.
A significant difference with donation site [OR= 0.3796, 95% CI =0.1852 – 0.7994, p= 0.013] with patients donating at fixe site been more represented as presented. The distribution of characteristic according to donation site shows significant difference with pre-donation SBP [OR= 0.4373, 95% CI =0.2073 – 0.9419, p= 0.0411;], Pre-donation DBP [OR= 0.4094, 95% CI =0.1779 – 0.9337, p= 0.027;], as well as the site of collection [OR= Infinity, 95% CI= 1435 – Infinity, p<0.0001]. Multivariate analysis revealed pre-pulse groups<100 [(OR= 151.360, 95% CI= 1.550 – 14778.786, p= 0.032)] and mild adverse events [(OR= 3276.663, 95% CI= 193.264 – 55519.818, p= 0.0000)].
Conclusion: Although, no deaths occurred among donors with adverse events, adverse events affect the safety of blood donors and decrease donors’ willingness to donate again. Thus, understanding risk factors of adverse events is important.
Breast cancer is one of the most common malignant tumors in women, with the highest incidence (Sung et al., 2021). Breast cancer is the sixth cause of cancer-related death among women in China, with about 169,000 cases and 45,000 deaths due to breast cancer each year (He et al., 2019). The peak age of breast cancer patients in China is 45-55 years old, and the age of the incidence group is younger, accounting for 19.9% of all new cancer cases in Chinese women (Liu Z C et al., 2021). With the continuous progress of medical technology, there is a trend of diversification of breast cancer treatment, and the benefits and risks of different treatment methods are different, which seriously affects the quality of life of breast cancer patients (Association, 2021; Kang Y K & Yuan F, 2022). Patients face an increasingly complex clinical decision-making process, and they need to weigh the risks and benefits of different treatment options, quality of life and their own economic conditions, and it is not easy to find the right treatment plan for their own.
With the change of the medical model, the role of the patient in the treatment decision-making process has become increasingly important, and the degree of patient participation in the treatment decision-making has become an important indicator to judge the quality of medical care (Savelberg, Boersma, Smidt, & van der Weijden, 2021). Shared decision-making (SDM) involves the joint participation of patients and health care professionals in making health care decisions based on the best available evidence and patient preferences (Ter Stege et al., 2022). Patient decision aids (DA) are an effective knowledge translation tool in supporting SDM and achieving patient-centered care. Matsen conducted a study on attitudes toward SDM in young breast cancer patients, showed that most young women tend to take an active role in decision-making (Matsen, Lyons, Goodman, Biesecker, & Kaphingst, 2019). Fang conducted a questionnaire survey on 480 breast cancer patients with nursing decision participation, and the study showed that 57.3% of the patients believed that their nursing decision participation attitude was positive, 40.2% of the patients believed that their nursing decision participation was actually high (Fang et al., 2019). Yamauchi reported 87% of patients who were diagnosed with breast cancer preferred to play active or collaborative roles and 78% of the patients actually played such decisional roles (Yamauchi, Nakao, Nakashima, & Ishihara, 2017). Peng revealed 64.8% of breast cancer patients preferred to play collaborative decision-making role (Peng, 2016). These data suggest that patients with breast cancer are likely to perform affirmative involvement in the treatment decision-making process. While, China’s medical staff have heavy workload and busy work, lack of time to communicate with patients, and difficulty to explain to patients the uncertain prognosis of disease treatment and other information, resulting in information asymmetry between doctors and patients, and patients are difficult to participate in treatment decision-making. Moreover, doctors do not recognize patients' preference to participate in treatment decision-making, and rarely encourage patients to participate in treatment decision-making and obtain patients' ideas (Sui, 2021), Thus affecting patients' participation in treatment decisions. Therefore, how to communicate effectively is a challenge for doctors, and how to make the most appropriate decision based on their preferences and values while fully understanding the pros and cons of various treatment options.
There is evidence to support the use of das by breast cancer patients. we conducted a systematic review of DA for patients making a decision with respect to multiple treatment modalities. which included 22 studies revealed that Ads are helpful to breast cancer patients by decreasing decisional conflict (Gao, Jin, Yu, Wu, & Han, 2021). Given the advantage, we decided to develop breast cancer DA and conduct pilot study, we therefore conducted a pilot testing to develop and evaluate a WeChat mini program-based breast cancer decision aid.
Study Design and Population
This cross- sectional study was conducted from January 2020 to December 2021 targeting blood donors at the blood bank unit of the Bafoussam Regional Hospital known to be the referral hospital of the Mifi Division, West region of Cameroon. The Bafoussam Blood Bank Unit area is approximately 1.146000, with 350 blood donations attendance per month and serves more than 27 medical institutions. All blood donors that accepted to participate in this study voluntarily signed an informed consent. There was no change in the standard procedure for blood donations during this study.
The criteria for eligibility of blood donation are in accordance with Cameroon Ministry of Health and Welfare guidelines.
Donor’s selection was based on anthropometric information such as age, height, weight, gender, BMI. Interview regarding past medical history, lifestyle and a limited clinical examination such as BP, pulse, hemoglobin level was conducted. Donors were of body weight, ≧ 50kg and a hemoglobin (Hb) level of ≧13.0g/dL for males and a body weight of ≧45kg and an Hb level of ≧12.0g/dL for females. Hb screening was based on copper sulfate density. Systolic blood pressure (SBP) was defined as 90 to160 mmHg and diastolic blood pressure (DBP) as50 to 95 mmHg.
Pulse rate was between 60 and100 beats per minute. There were 2 volumes of whole blood (WB) donations, 250mL and 450mL. Donation intervals were 3 months. All the participants in this study were eligible to donate blood. Half a liter of mineral water was offered to each participant prior to donation and snacks, coffee, juice or milk were issued at post donation during their resting for 10 to 15 minutes.
Data and Specimen Collection
Donor records were obtained from participant questionnaire sheet. They included collection (date, status and site), donation volume, and number of donations. BMI was defined as body mass divided by the square of body height and estimated blood volume (EBV) was calculate using the following equations (height, in meters; weight, in kg). Female donors: blood volume (L)=0.3561(Height)3 + 0.03308(Weight)+0.1833).
Male donors: Blood volume (L)= 0.3669 (Height)3 +0.03219 (Weight)+0.6041.
Ascertainment of Adverse events
Adverse donor reaction:
A list of observed and/or donor reported signs/symptoms that occurred during or up to a week after donation were recorded. Signs/symptoms were categorized as mild adverse events (chills, nausea, pallor, dizziness, vomiting, nervousness, headache) and severe adverse events (hypotension, muscle contractions, convulsions, fainting, syncope, respiratory problems or emesis) [1, 10-13]. In case the donor manifested both mild and severe signs/symptoms simultaneously, they were accounted as severe adverse events.
Statistical analysis: The variables, age, BMI, pre-donation SBP, pre-donation DBP, and EBV were dichotomized by their median values. All statistical analyses in this study were performed using GraphPad Prism software version 8.0.2. Chi-squared test and t test were respectively used for binary variables and continuous variables to compare the baseline demographic characteristics of the case and control groups statistical software. A univariate logistic regression model was then used to analyze the strength of association between potential factors and adverse events. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Multiple logistic regression analysis was performed to identify the independent risk factors for adverse reactions to adjust for potential important confounders. The P-value of the test was 2-tailed with a level of significance (a)=0.05. A P-value of less than 0.05 indicated statistical significance.
All demographic characteristics converted to dichotomous variables were coded as 0 or 1 by the medium values.
Demographic Characteristics of Study Participants
A total of 252 whole blood donors accepted to participate in this study. The mean age (±SD) of the study population was 29.82 ± 8, 56 years, and the ages ranged from 18 to 61 years.
Of the study population, donors age <35>0 Frequency Percentage Age <35> 194 77.0 ≧35 58 23.0 Gender Female 52 20.6 Male 200 79.4 Educ level Primary 28 11.1 Secondary 123 48.8 Tertiary 101 40.1 Profession Skilled Workers 116 46.0 Unskilled workers 54 21.4 Students 67 26.6 Unemployed 15 6.0 Marital status Married 100 39.7 Unmarried 152 60.3 Don type Voluntary 118 46.8 Replacement 134 53.2 Total 252 100.0
Table 1: Sociodemographic characteristics of blood donors
Characteristics of adverse events of study subjects.
The characteristics of adverse events of study subject show a significant difference with donation site [OR= 0.3796, 95% CI =0.1852 – 0.7994, p= 0.013] with patients donating at fixe site been more represented as presented as shown in table 2.
| Positive | Negative | ||||||
| Effective | % | Effective | % | p-value | OR | 95% CI | |
| Gender | |||||||
| Female | 18 | 7.14 | 34 | 13.49 | 0.299 | 1.468 | 0.7614 - 2.777 |
| Male | 53 | 21.03 | 147 | 58.33 | |||
| Age | |||||||
| <35> | 60 | 23.81 | 134 | 53.17 | 0.0958 | 1.913 | 0.9338 - 4.009 |
| ≧35 | 11 | 4.37 | 47 | 18.65 | |||
| Predonation SBP (mmHg) | |||||||
| <124> | 38 | 15.08 | 81 | 32.14 | 0.0958 | 1.913 | 0.9338 - 4.009 |
| ≧124 | 33 | 13.10 | 100 | 39.68 | |||
| Predonation DBP (mmHg) | |||||||
| <75> | 42 | 16.67 | 99 | 39.29 | 0.5738 | 1.2 | 0.6888 - 2.060 |
| ≧75 | 29 | 11.51 | 82 | 32.54 | |||
| Prepulse | |||||||
| <100> | 69 | 27.38 | 173 | 68.65 | 0.7298 | 1.595 | 0.3767 - 7.612 |
| ≧100 | 2 | 0.79 | 8 | 3.17 | |||
| BMI groups | |||||||
| <24> | 19 | 7.54 | 56 | 22.22 | 0.5441 | 0.8156 | 0.4498 - 1.485 |
| ≧24 | 52 | 20.63 | 125 | 49.60 | |||
| Number of donations | |||||||
| First-time | 42 | 16.67 | 84 | 33.33 | 0.0925 | 1.672 | 0.9616 - 2.872 |
| Repeated | 29 | 11.51 | 97 | 38.49 | |||
| donation site | |||||||
| Fixed | 55 | 21.83 | 163 | 64.68 | 0.0131 | 0.3796 | 0.1852 - 0.7994 |
| Mobile | 16 | 6.35 | 18 | 7.14 | |||
| Collection volume | |||||||
| 450 | 34 | 13.49 | 91 | 36.11 | 0.7802 | 0.9088 | 0.5201 - 1.577 |
| 250 | 37 | 14.68 | 90 | 35.71 | |||
Table 2: Characteristics of study subjects
Adverse events occurred in donors who were not significantly associated in Mean biomarkers for donors with and without adverse events as presented in table 3.
Table 3: Mean biomarkers for donors with and without adverse events.
The distribution of characteristic according to donation site shows significant difference with pre-donation SBP [OR= 0.4373, 95% CI =0.2073 – 0.9419, p= 0.0411;], Pre-donation DBP [OR= 0.4094, 95% CI =0.1779 – 0.9337, p= 0.027;], as well as the site of collection [OR= Infinity, 95% CI= 1435 – Infinity, p<0>characteristics Fixed Mobile Effectif % Effectif % p-value OR 95%IC% Gender Female 44 17.46 8 3.17 0.6516 0.8218 0.3547 - 1.846 Male 174 69.05 26 10.32 Age <35> 168 66.67 26 10.32 >0.9999 1.034 0.4647 - 2.364 ≧35 50 19.84 8 3.17 Pre SBP <124> 97 38.49 22 8.73 0.0411 0.4373 0.2073 - 0.9419 ≧124 121 48.02 12 4.76 Pre DBP <75> 116 46.03 25 9.92 0.0273 0.4094 0.1779 - 0.9337 ≧75 102 40.48 9 3.57 Prepulse groups <100> 208 82.54 34 13.49 0.3665 0 0.000 - 2.184 ≧100 10 3.97 0 0.00 BMI groups <24> 65 25.79 10 3.97 >0.9999 0.9957 0.4570 - 2.169 ≧24 153 60.71 24 9.52 Number of donations First-time 114 45.24 12 4.76 0.0959 2.01 0.9340 - 4.236 Repeated 104 41.27 22 8.73 donation site Fixed 218 86.51 0 0.00 <0> Infinity 1435 - Infinity Mobile 0 0.00 34 13,49 Collection volume 450 111 44.05 14 5,56 0.3573 1.482 0.6962 – 3.187 250 107 42.46 20 7,94
Table 4: Mean biomarkers for donors with and without adverse events
| Estimation | Standard Error | Wald | p-value | OR | 95% CI | |
| Gender(Female) | 1.818 | 1.306 | 1.938 | 0.164 | 6.161 | 0.48 - 79.71 |
| Age groups(<35> | 0.477 | 1.097 | 0.189 | 0.664 | 1.611 | 0.19 - 13.83 |
| Number of donations(First time) | -2.174 | 1.079 | 4.059 | 0.044 | 0.114 | 0.01 - 0.94 |
| volume collected (450 ml) | -0.602 | 0.807 | 0.558 | 0.455 | 0.547 | 0.11 - 2.66 |
| donation site (Fixed) | 0.180 | 1.074 | 0.028 | 0.867 | 1.197 | 0.15 - 9.83 |
| PRE-SBP | 0.020 | 0.029 | 0.485 | 0.486 | 1.020 | 0.96 - 1.08 |
| PRE-DBP | 0.041 | 0.031 | 1.688 | 0.194 | 1.042 | 0.96 - 1.11 |
| BMI | 0.005 | 0.095 | 0.002 | 0.962 | 1.005 | 0.83 - 1.21 |
| Level of ADR | 35.839 | 0.000 | ||||
| Mild | -7.480 | 1.249 | 35.839 | 0.000 | 0.001 | 0.00 - 0.007 |
| Moderate | -26.981 | 10692.870 | 0.000 | 0.998 | 0.000 | NA |
| Severe | -27.327 | 10441.869 | 0.000 | 0.998 | 0.000 | NA |
| Pre-pulse groups (<100> | -4.135 | 1.889 | 4.793 | 0.029 | 0.016 | 0.00 - 0.65 |
| Constance | 3.299 | 5.054 | 0.426 | 0.514 | 27.081 |
Table 5: Odds ratios and 95% confidence intervals from univariate logistic
Donors With Adverse Events
Risk factors identified as predicting a responsive outcome from the donors with adverse events were the first-time donation [(OR= 0.0114, 95% CI= 0.01 – 0.94, p= 0.044)], the mild adverse event [(OR= 0.001, 95% CI= 0.00 – 0.007, p= 0.000)], the pre-pulse groups (<100 xss=removed xss=removed xss=removed> Estimate Standard Error Wald p-value OR 95% CI Constante PRE-SBP -0,012 0,045 0,074 0,785 0,988 0,904 - 1,080 PRE-DBP 0,000 0,062 0,000 0,995 1,000 0,886 - 1,129 Pre Pulse 0,022 0,036 0,361 0,548 1,022 0,952 - 1,097 BMI -0,109 0,147 0,545 0,460 0,897 0,672 - 1,197 Gender Female -1,687 1,385 1,483 0,223 0,185 0,012 - 2,795 Male 0b - Age <35> -0,915 1,153 0,630 0,427 0,400 0,042 - 3,835 ≧35 0b - Type of donation Voluntary -0,957 1,052 0,828 0,363 0,384 0,049 - 3,019 Replacement 0b - Pre SBP <124> 0,366 1,329 0,076 0,783 1,442 0,107 - 19,503 ≧124 0b - Pre DBP <75> 1,631 1,651 0,976 0,323 5,112 0,201 - 130,082 ≧75 0b - Pre-pulse <100> 5,020 2,337 4,612 0,032 151,360 1,550 - 14778,786 ≧100 0b - BMI <2> -0,956 1,219 0,615 0,433 0,384 0,035 - 4,191 ≧24 0b - Number of donation First time 2,154 1,151 3,504 0,041 8,619 0,904 - 82,212 Repeated 0b - Volume of Blood 450 ml -0,119 0,927 0,017 0,898 0,887 0,144 - 5,460 250m] 0b - ADR Mild 8,094 1,444 31,420 0,000 3275,663 193,264 - 55519,818 Moderate 28,129 0,000 1645509709456,500 1645509709456,500 - 1645509709456,500 Severe 27,525 0,000 899473078512,125 899473078512,125 - 899473078512,125 No 0b -
Table 6: Odds ratios and 95% confidence intervals from multiple logistic
| Demographic characteristics | Adverse events n=181 | No adverse events n=71 | OR | OR 95%CI | p-value |
| Female, <35> | 11 | 12 | 0,3181 | 0,133 - 0,759 | 0,0131 |
| Female, <35> | 12 | 4 | 1,189 | 0,370 - 3,818 | >0,9999 |
| Female, ≧35, First-time | 3 | 0 | 1,189 | 0,370 - 3,818 | >0,9999 |
| Female, ≧35, Repeated | 8 | 2 | 1,595 | 0,330 - 7,702 | 0,7298 |
| Male, <35> | 61 | 28 | 0,7807 | 0,442 - 1,376 | 0,464 |
| Male, <35> | 50 | 16 | 1,312 | 0,688 - 2,501 | 0,4314 |
| Male, ≧35, First-time | 9 | 2 | 1,312 | 0,688 - 2,501 | 0,4314 |
| Male, ≧35, Repeated | 27 | 7 | 1,714 | 0,709 - 4,141 | 0,3097 |
Table 7: Joint effect of gender, age and number of donations on adverse events
Results of multiple logistic regression analysis are shown in Table7. Multivariate analysis revealed pre-pulse groups<100 xss=removed xss=removed xss=removed xss=removed xss=removed xss=removed>
At mobile donation sites, the independent risk factors of pre-pulse (<100>
The ORs of 3 major risk factors (age, gender, and donation status) were analyzed simultaneously as demonstrated in Table 8. Male repeated donors aged ≧35 years were treated as the reference group.
Male repeated donors aged <35years p=0,0131).>
Our findings showed that the most significant risk factor for adverse events is first-time blood donor with pre-donation DBP and level of adverse reaction were two significant factors with strong association. In a research conducted in Taiwan, first-time donors are not recommended to donate 500 mL of WB or platelets apheresis to prevent adverse reaction. From 2010 to 2014, 1.86% of males and 0.013% of females aged 20 to 65 years donated 500 mL as first-time donors at the Taichung Blood Center but also in the study conducted by Wand et al. 2019 [7]. From the findings of this study, factors associated with adverse events related to blood donation include Pre-Diastolic Blood Pressure and level of adverse reaction blood donation.
First-time donors might be more anxious and fearful than repeated donors as they have had no experience donating blood. Anxiety has direct emotional consequences that can lead to VVR [14]. More experienced blood donors have less fear [15]. Fear may be a predictor of adverse events [16, 17]. Almutairi H et al also reported that first-time donors have a 2.2-fold increased risk of adverse events [18]. Moreover, first-time donors with adverse reaction experience maybe less likely to donate again [19]. Many studies have shown that female gender is associated with VVRs, highlighting the gender differences in incidences of adverse reactions [20]. Gender differences in autonomic functions are associated with differences in BP. There is also gender differences in the renin angiotensin system and the effects of bound angiotensin II type2 receptor on renal vascular resistance. Renal sympathetic nervous activity is the main cause of vascular resistance in the evaluation of BP in female subjects. [20]. In this study, we also found a higher risk of VVR among female donors than among male donors.
In addition, blood donors who donated at mobile site had higher risk of VVR than those who donated at fixed site. The reasons maybe less space and less relaxed environment at mobile sites. It is important to ensure that mobile site shave adequate ventilation and space for blood donors to rest for at least 15 minutes after donation.
To illustrate the joint effect of the 3 most significant factors, a multiple logistic regression model was used to assess the combinations of age, gender, and donation status. We found that the combined effects of any 2 or 3 factors resulted to a stronger association than any 1 factor alone.
Adverse events are thought to be caused by various physical (e.g., standing up after donating blood) and psychological reasons (e.g., pain, fear). [22]
Moreover, neural mediated reflex, relatively mediated reflex, relative hypovolemia, posture change, [23] and evaluated serum protein and Hemoglobin [24] can lead to adverse events.
Aging of the population is a global challenge for blood services [25,26]. Effective strategies for recruitment and retention of young, first-time blood donors are very important. Prevention of adverse events is also of importance to blood centers as blood donors who experience adversary are less likely to give blood again. Reducing adverse events improves donor retention [27]. VVR is the most common adverse event among WB donors. [28]. Therefore, it is important to understand and prevent adverse events related to blood donation and to improve blood donation safety.
This study has several limitations. Teenage blood donors have significant risk of adverse reactions and injuries after blood donation when compared with adults. Secondly, one of the criteria for blood donors was pulse rate of 60 to 100 beats per minute. Pulse Rate is measured at blood centers, but this data is not recorded. Third, Hb screening for blood donors was based only on copper sulfate, meaning no quantitative Hb data. A previous study showed that higher Hb level is associated with adverse events for WB donations. Blood donors are healthy with normal cardio-vascular and renal functions. They can manage as lightly negative balance in water normally, but not when it is due to blood loss. If there is a negative balance of water during blood donation, loss of intravascular volume may not be supported [18]
Although, no deaths occurred among donors with adverse events, adverse events affect the safety of blood donors and decrease donors’ willingness to donate again. Thus, understanding risk f actors of adverse events is important.
Pre-pulse <100>
After controlling for other important demographic and health factors, VVRs are more likely to occur among fearful blood donors. At Bafoussam Blood Center donation sites, first-time donors are given a silicone bracelet to wear before phlebotomy. This bracelet Tre minds staff members to pay more attention to them. They explain the process and chat with donors to divert their attention and reduce psychological stress. Providing a comfortable and friendly environment for donors is important. Based on the results of this study, we can educate staff at donation sites regarding risk factors and identification of those at risk to prevent adverse events. The collection staff should be well trained in collecting techniques to minimize adverse reactions such as nerve injury or pain. Further, if appropriate interventions such as practicing applied muscle tension for increasing BP are carried out, we speculate that incidences of adverse reactions can be reduced.
Ethical Considerations
Ethical clearance was obtained from the National Ethical Committee for Research in charge of Human Health from the University number under the application number1244-04 from the18th May 2020. Research authorizations were also obtained from the Director of regional Hospital Bafoussam and consents were obtained from each participant before inclusion in the study
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.
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
