AUCTORES
Globalize your Research
Case Report | DOI: https://doi.org/10.31579/2692-9759/054
1 Department of Internal Medicine, Faculty of Medicine and Health Sciences, Alneelain University, Khartoum, Sudan
2 Interventional cardiology, Ahmad Gasim Cardiac Centre, Ahmad Gasim Hospital, Khartoum North, Sudan
3 Sudan Medical Specialization Board (S.M.S.B), Internal Medicine Council
4 Medical Biochemistry and Molecular Biology, Khartoum, Sudan.
*Corresponding Author: Hayder A Giha, Medical Biochemistry and Molecular Biology, Khartoum, Sudan.
Citation: Osman Al-Sayed Osman Alamin, Omer Amir, Hayder A Giha (2022) Correlates and Severity of Left Ventricular Hypertrophy in Type 2 Diabetes Patients in an Afro-Arab-cross Ethnic Community. Cardiology Research and Reports. 4(4); DOI: 10.31579/2692-9759/054
Copyright: © 2022 Hayder A Giha, 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 March 2022 | Accepted: 05 April 2022 | Published: 22 April 2022
Keywords: T2DM; left ventricular hypertrophy; left ventricular mass index; relative wall thickness; afro-arab ethnicity
Background: The cardiovascular (CV) diseases, including left ventricular hypertrophy (LVH) are major causes of morbidity and mortality in T2DM. The LVH is associated with ventricular arrhythmias, ischemic heart disease (IHD), heart failure and sudden death. Although the LVH is frequent in T2DM, screening for this disorder is frequently done.
Material and Methods: In this study, 120 Sudanese T2DM patients were recruited, (70 with and 50 without LVH) from four cardiac centers in Khartoum, the latter is inhabited by most of the Sudanese Afro-Arab ethnic groups. Clinical data were obtained from almost all patients together with measurement of glycemic and renal parameters. Echocardiography was performed for each patient, the left ventricle geometry components including the relative wall thickness (RWT) were estimated and the left ventricle mass index (LVMI) was calculated.
Results: The commonest LVH type was eccentric (65.7%), and grade was severe (37.1%), and both were strongly associated, p<0.001, while the frequency of the mild LVH was 28.6%. Out of 10 tested variables only HhA1c (p<0.001), urea (p=0.039) and creatinine (p=0.043) were significantly associated with LVH, while the sex, age, T2DM duration, smoking, obesity, random and fasting blood glucose were not. Moreover, the LVMI was positively correlated with HbA1c (CC0.188, p<0.039), and negatively with RWT (CC-0.495, p<0.000). Finally, significantly higher number of patients with IHD (p=0.038) and cerebral complications (p=0.014) had LVH.
Conclusion: In this unique setting of interethnic cross, the results suggest that more genetic than environmental factors could be involved in diabetic LVH development.
T2DM Type 2vDiabetes mellitus
LVH Left ventricular hypertrophy
LVMI Left ventricle mass index
IHD Ischemic heart disease
CNS Cardiovascular
PVD High density lipoprotein
FBG Fasting plasma glucose
RBG Random plasma glucose
MW Mann-Whitney Rank Sum Test
KW Kruskal-Wallis One Way Analysis of Variance
on Ranks
c2 Chi-square
RWT Relative wall thickness
IR Insulin resistance
IDF International Diabetes Federation
2H-OGTT 2-hours oral glucose tolerance test
IVS Interventricular septal thickness
BMI Body mass index
AV One Way Analysis of Variance
OHA Oral hypoglycemic agents
Diabetes mellitus (DM) is a chronic metabolic disorder characterized by hyperglycemia due to impaired insulin secretion, insulin resistance (IR), or both. The DM is proving to be a global public health burden, according to the latest 2019 data from the International Diabetes Federation (IDF), approximately 463 million adults had DM [1], this number is expected to increase by another 200 million by 2040 [2]. Type 2 diabetes mellitus (T2DM) makes up about 85-90% of all DM cases [1]. The prevalence and incidence rates of DM in Sudan, as in many other low-income countries, are increasing to epidemic levels, leading to emergence of a public health problem of major socio-economic impact [3,4]. In Sudan, DM is associated with poor glycemic control, high prevalence of complications, and low quality of life [5,6]. As well as, DM is the commonest cause of hospital admissions due to a non-communicable disease in Sudan, with an overall increased age-adjusted mortality and reduced life expectancy of about 5–10 years [7].
It is well established that various left ventricle (LV) abnormalities are strongly promote cardiac disease and death, in particular the left ventricular hypertrophy (LVH) and LV systolic dysfunction (LVSD) [8]. Impaired long axis contraction of the LV may also be associated with increased mortality. Furthermore, LV diastolic filling abnormalities has been shown to place an individual at an increased cardiovascular (CV) risk and is associated with impaired exercise tolerance [9]. The LVH is a condition in which there is an increase in LV mass, either due to an increase in wall thickness or due to left ventricular cavity enlargement, or both. Most commonly, the LV wall thickening occurs in response to pressure overload, and chamber dilatation occurs in response to volume overload [10]. Hypertension and aortic valve stenosis are the most common causes of LVH, in both conditions; the heart is contracting against an elevated after-load leading to concentric LVH as a result of an abnormal increase in LV myocardial mass [11]. Increased filling of the LV leads to diastolic overload, which is the underlying mechanism for eccentric LVH in patients with aortic or mitral regurgitation as well as in the case of dilated cardiomyopathy [10,11].
In LVH, the sustained increase in wall stress along with cytokine and neuro-activation stimulates the development of myocardial hypertrophy or increasing muscle thickness and deposition of the extracellular matrix [11], with concomitant development of myocardial fibrosis. Initially, fibrosis is clinically manifested by diastolic dysfunction, but systolic dysfunction also develops with progressive disease.
The DM is associated with LVH, LV diastolic dysfunction, LV systolic dysfunction and cardiac autonomic neuropathy [12,13]. A large proportion of patients with T2DM whom are not known to have a primary CV disease, have LVH [14], and the regression of LVH by pharmacological intervention is associated with an improvement in prognosis [15], which are objective clues for the link between DM and LVH. The IR, which frequently accompanies T2DM, is reported to be associated with LVH [16]. Moreover, the T2DM and IR are closely associated with obesity.
The complications of T2DM are common and largely account for the excess morbidity and mortality associated with this disease. As such routine screening of asymptomatic patients with T2DM for retinopathy, nephropathy and neuropathy is recommended. However, the DM is a major risk factor for ischemic heart disease (IHD), cardiomyopathy, and congestive heart failure, which are all the most important causes of morbidity and mortality in T2DM, accounting for approximately half of total mortality [17]. T2DM is associated with a high prevalence of hypertension, dyslipidemia, and microalbuminuria, which are all known as independent CV risk factors. Even in populations with low CV risk, DM is associated with an increased incidence of CV death [18].
Genetic and ethnic difference in susceptibility to the different DM complications is well known. The Sudanese are relatively heterogeneous population with marked cross–ethnic breed, due to the intermarriage between different tribes unlike the case in the Arab, African or American societies where there are clear ethnic segregation as in USA [19] and sub-Saharan Africans [20], and familial segregation (consanguinity) as in Arabic settings [21]. In Sudan the original Africans have frequent inter marriage with the Arabs and other ethnicities [22].
The LVH is a strong predictor of CV disease among T2DM patients. The objective of this study was to determine the type and severity of LVH in T2DM as well as the risk factors, including the association with other diabetic complication, but in a different setting of patients with different genetic complexion.
Study design and area
This is a descriptive multicenter cross-sectional hospital-based study, conducted in Omdurman Teaching Hospital, Alshab Teaching Hospital, Ahmed Gasim Hospital and Alsalam Cardiac Center, in the period between April and August 2021.
Study population
The study subjects, men and women, are adult Sudanese patients, aged between 30-85 years and known to have T2DM. All diabetic patients referred from diabetic clinics or came for CV checkup to the above mentioned national cardiac centers, presented during the study period and accepted to participate in this study, were included. The exclusion criteria were; hypertension, aortic stenosis, hypertrophic obstructive cardiomypathy, severely ill patients and professional athletics.
The T2DM diagnosis in Sudan is based on either the estimation of plasma glucose [fasting plasma glucose (FPG), 2-hours oral glucose tolerance test (OGTT) and random plasma glucose (RBG)] or HbA1c. For diagnosis of T2DM the following were nationally approved: a FPG of ≥ 126 mg/dL (7.0 mmol/L), 2-h OGTT ≥ 200 mg/dL (11.1 mmol/L), RBG ≥ 200 mg/dL (11.1 mmol/L) or HbA1c ≥ 6.5% (48 mmol/mol), along with symptoms of hyperglycemia/DM. The HbA1c has also been accepted for T2DM diagnosis [23]. However, all study subjects were known to be T2DM patients.
Echocardiogram: According to the American Society of Echocardiography, the echocardiogram is the test of choice in diagnosis of LVH. Its sensitivity is significantly higher than ECG, and the test can also detect other abnormalities such as left ventricular dysfunction (systolic as well as diastolic) and valvular heart disease. Cardiac ultrasound utilizes transthoracic or transesophageal positioning of the transducer to measure the end-diastolic interventricular septal thickness (IVS), LV internal diameter, and posterior wall thickness. From these measurements and the patient’s height and weight, the LV mass index was determined. The LVH was diagnosed when LV mass index (LVMI) was >115 g/m2 in men and >95 g/m2 in women. The LVMI (LVM [left ventricular mass] normalized for body surface area or height) is calculated using the following equation: LVMI = LVM/body surface area. The LVM = 0.8 [1.04 (LVEDD + IVSd +PWd)3 - LVEDD3)] + 0.6 (Devereux et al'2000 [24]). The LVH were categorized according to the Relative Wall Thickness as follow: RWT= Posterior wall thickness x 2 / LV internal diameter at end-diastole. Based on RWT, and the LVMI, the LVH can be categorized into 2 types; concentric hypertrophy (increased LVMI and RWT more than 0.42) or eccentric hypertrophy (increased LVMI and RWT less than or equal to 0.42) [11].
Data collection tools
Data was collected through structured questionnaires consisting of the following parameters: demographic, social, clinical, therapeutic and laboratory investigations.
The LVH was the dependent variable, while the independent variables were; demographic data (age, gender, BMI), smoking, T2DM duration, diabetic complications and the laboratory variables (blood glucose, HbA1c, urea, creatinine). Data was analyzed by using a computer program Sigma Stat software, p value was considered as significant at level <0>
Ethical consideration
An ethical approval was obtained from Sudan medical specialization board (SMSB). Data used anonymously by using identity numbers to protect patient’s identity. An oral informed consent was obtained from each patient.
Characteristics of the study subjects
As seen in (Table 1), 120 T2DM patients were enrolled in this study, 50 patients without and 70 patients with LVH. Overall, 61.7% (74) were males and 38.3% (46) were females, their mean age was 59.8±11.3, (range 30.0-85.0), and 23.3% (28) of all the patients were smokers. The mean of their BMI was 28.8± 4.1, 20.0 - 39.0 kg/m, with 45% (54) were considered as obese (data not shown). The mean duration of their DM was 12.4± 7.1 (range 1.0 - 30.0) years. Most of the patients (61.7%, 74) were using oral hypoglycemic agents (OHA), 31.7% (38) insulin, 5% (6) both OHA and insulin and 1.7% (2) were on diet control (Table 2)
Clinical and laboratory profiles: The frequencies of the diabetic complications were as follows; ischemic heart disease (IHD) 15% (18); renal disease 10% (12); central nervous system (CVS) disease 8.3% (10); and peripheral vascular disease (PVD) 5% (6) (Table 4).
The biochemical tests’ results were as follows; mean FBG was 123.7 ± 32.2 (range 78.0 - 211.0) mg/dl, RBG was 227.4 ± 67.0 (range 111.0 - 444.0) mg/dl, and mean of HbA1c was 8.8 ± 1.9 (range 6.0 - 12.7). For the renal function tests, the mean plasma level of urea was 49.2 ± 27.1 (14.0 -148.0) mg/dl and creatinine was 1.04 ± 0.61 (range 0.40 - 4.50) mg/dl (Table 1).
The LVH types and severity in T2DM: Out of 120 patients with T2DM, 58.3% (70) had LVH (cases) and 41.7% (50) had no LVH (control). Based on RWT, the prevalence of the eccentric LVH was 65.7% (46) and that of the concentric LVH was 34.3% (24), while the mean RWT was 0.399 ± 0.093 (Table 1). The LVH was severe in 37.1% (26/70) of the cases, in 34.8% (24/70) was moderate and in 28.6% (20/70) it was mild (Table 3). The mean of the LVHI in all study subjects was 116.8 ± 36.7 g/m2, and it was139.0, 121.0 - 158.0 in the cases and 86.0, 77.0 - 95.0, in the controls, p 0.001 (Table 1).
KW = Kruskal-Wallis One Way Analysis of Variance on Ranks
AV=One Way Analysis of Variance
The T2DM patients with and without LVH were of comparable sex distribution although males were more dominant in the former group, male to female ratio of 1.9:1 vs. 1.3:1, respectively, p 0.374 c2. The two groups had comparable mean age, 61.4±12.2 vs. 57.7±9.6 yrs., respectively, p 0.078. Moreover, both groups had comparable, T2DM disease duration (p 0.495), frequency of cigarette smoking (p 0.166), and BMI (p 0.285). The frequency of obesity (BMI ≥30kg/m) is comparable between the two study groups, 59.3% vs. 40.7%, p1.00 (Table 2). Also the usage of OHG (oral hypoglycemic drugs) and insulin was not significantly different between the patients with and without LVH, p 0.815 (Table 2). Of the T2DM complications, the prevalence of the renal (p 0.123) and PVD (p 0.089) diseases, were also comparable between the two groups. The biochemical profiles showed that the RBG (p 0.111) and FBG (p 0.063) were not significantly different between the T2DM patients with and without LVH, (Table 1). However, the prevalence of the IHD and renal complications were significantly higher in patients with LVH, p 0.038 and p 0.014, respectively. As well as, the HbA1c (p <0>
Note: 6 patients (5%) used both OHA and insulin, and 2 patients (1.7%) were on diet control, 2 from the former had mild LVH, while the rest (6) didn’t had LVH.c2= Chi-square, LVH= left ventricular hypertrophy, BMI= body mass index, OHA= oral hypoglycemic agent
For the variants which were significantly different between the study groups, the correlation analysis showed significant positive correlations between the LVMI and HbA1c, CC 0.641, p< 0>
correlated with the former variables which were all significantly positively inter-correlated (Figure. 1). The other variables, the disease duration (p 0.608), BMI (p 0.458), RBG (p 0.234) and FBG (p 0.845) were not correlated with the LVMI.
Finally, 52.2% (24) of the patients with eccentric LVH had severe, 34.8% (16) had moderate and only 13% (6) had mild LVH, while 8.3% (2) of patients with concentric LVH had severe, 33.3% (8) had moderate and 58.3% (14) had mild LVH, p <0>
As seen in (Table 3, and Figure. 2), limiting the analysis to T2DM patients with LVH only, the prevalence of the three grades of LVH, mild, moderate and severe were 28.6% (20), 34.3% (24), and 37.1% (26), respectively. The three subgroups had similar median age distribution, 63.5, 53.0-70.0; 64.0, 59.5 - 65.0; 65.0, 55.0 - 68.0 years, respectively, p 0.880, mean T2DM disease duration, 14.3 ± 6.4; 11.8 ± 6.8; and 12.6 ± 8.1 years, respectively, p 0.516, and median BMI, 28.0, 24.0-32.0, 27.0, 25.5-31.5, and 31.0, 27.0 - 33.0 kg/m2, respectively, p 0.221. Among the glycemic parameters (RBG, FBG, and HbA1c), only higher HbA1c was significantly associated with LVH severity, 8.6, 8.0- 9.5; 9.2, 9.0 - 11.5; and 11.0, 10.0 - 12.0, respectively, p <0>
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.
