AUCTORES
Globalize your Research
Review ariticle | DOI: https://doi.org/10.31579/2690-4861/730
*Corresponding Author: Christopher Turner, Specialist in Restorative Dentistry (Rtd) Bath UK.
Citation: Christopher Turner, (2025), Diabetes Mellitus and its Sixth Complication Explained, International Journal of Clinical Case Reports and Reviews, 24(4); DOI:10.31579/2690-4861/730
Copyright: © 2025, Christopher Turner. 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: 04 March 2025 | Accepted: 07 March 2025 | Published: 24 March 2025
Keywords: diabetes; periodontitis; co-morbidity; professional co-operation
In 1999 Löe described periodontal disease (PD) as the sixth complication of diabetes mellitus (DM) because this latter group of patients has a 3 – 4 times greater risk of developing PD when compared with non-diabetics. This rises to 10 times for smokers.
DM and PD are inter-related, one disease affecting the other and vice versa. The exact mechanism is unclear but may be related to inflammation, blood markers for which are raised in both diseases.
From the medical point of view there are five complications of DM namely cardiac, vascular, renal, ophthalmic and neurological that can be visualised as a simple hub called DM with spokes for the above complications.
However, the research evidence has shown that the severity of all these five complications is worse when patients have active, uncontrolled PD. When PD is treated, there is an improvement in glycaemic control.
These results have led to the conclusion that PD is not a separate complication of DM but a co-morbidity factor acting by: modifying the severity of another disease and modulating the severity of diabetic complications in the manner of a rheostat. A new model is proposed together with a system for doctors and dentists to work together.
There are likely to be wide variations in outcomes depending on both the bacteriological load from mature dental plaque and individual immune responses.
More focussed research is required.
The concept that periodontal disease was the sixth complication of diabetes mellitus (DM) dates back to a paper by the distinguished Scandinavian periodontist Professor Harald Loë in 1999 when he attempted to inform doctors about the increased risk that people living with diabetes had of developing periodontal disease (PD) [1]. In fact, the first description of this was much earlier by Williams in his paper entitled ‘Diabetic Periodontoclasia’ published in 1928 and forgotten [2]. Nearly 100 years later as dentists we still have difficulty persuading too many doctors about this connection. We now know that this risk is about 3-4 times greater than for non-diabetics, rising to 10 times for diabetics who smoke [3].
Pathophysiology
From the medical point of view there are five complications of diabetes mellitus namely, cardiac, vascular, renal, ophthalmic and neurological. We can visualise this simply as a hub called diabetes mellitus with spokes for the above complications (Figure 1).
Where does periodontitis fit in? Is it another spoke? Decidedly not. The evidence is overwhelming that diabetes and periodontitis are interrelated, one disease affecting the other and vice versa [4,5], so the model relationship has to have both diabetes and periodontitis at a much larger hub with an inter-relationship (Figure 2). More importantly, the research evidence has shown that the severity of all these five diabetic complications doctors have to deal with is worse when patients have active, uncontrolled periodontitis. Also, when periodontitis is treated, there is an improvement in glycaemic control [6].
The relationship between DM and PD may be inflammatory in origin. There is a common pathogenesis involving an enhanced inflammatory response at both local and systemic levels7. This is caused by the chronic effects of hyperglycaemia and the formation of advanced glycation end-products that promote the inflammatory response [7]. Levels of C-reactive protein4, tissue necrosis factor [7], and cytokines [8] are raised in both diseases. Polysaccharides in Gram negative bacteria in mature dental plaque are known to stimulate the production of cytokines. Toxic products from these organisms initiate tissue breakdown and increased osteoclastic bone resorption in the periodontium [9]. Osteoclastic activity also increases along with enhanced glycation levels and poor glycaemic control [10], thus stimulating further bone resorption and diminished bone formation in a vicious circle and contributing to the enhanced levels of periodontitis and alveolar bone loss seen in people living with diabetes.
When dental plaque is left, after seven to ten days gingival inflammation ensues and this is the precursor of periodontitis [11].
PD may be thought of as an infection. However, it is not in the true medical sense of the word because it does not meet Koch’s postulates for a single recoverable infective agent. PD is a chronic hyper sensitivity reaction to antigens in mature dental plaque.
Research has shown that when the severity of diabetic complications is compared to periodontal status that for:
Cardiac and Vascular: Poor oral health is associated with atherosclerotic cardiovascular disease. This interaction raises cardiac morbidity fourfold and is associated with chronic infection mediators which may lead to the initiation of endothelial dysfunction [12].
Nephropathy: People on dialysis are at greater risk of developing PD [13]. With severe Periodontitis there is a 2.6 times greater risk of macroglobinaemia and a 4.9 times risk of end stage renal disease [14]. Periodontal management may contribute to the prevention of renal disease [15]. Patients should be screened for periodontitis before acceptance onto dialysis programmes [16].
Neuropathy; Is a microvascular complication associated with xerostomia in 40 per cent of people living with diabetes mellitus [17]. The increased risk of caries goes without saying. There is an inverse relationship between salivary flow and glycated haemoglobin (HbA1c) levels that may be due o disturbances in glycaemic control [18].
Retinopathy: There are few studies of this complication together with PD using different criteria [19,20]. However, an increase in the severity of diabetic retinopathy is associated with the components of periodontal disease [21].
How might this affect the medical model? It is clear that periodontitis is influencing diabetic’s individual responses. It is both
This is a new concept and means that PD should not be regarded as a complication of DM but a co-morbidity factor. Therefore, for optimum treatment of people living with diabetes there has to be both medical and dental contemporaneous input into their care. When both are treated together there may be a synergistic effect [22].
It is expected that there will be wide variations in individual patient responses depending upon the bacteriological load from their plaque, and their immune response.
In summary, the new model shows dentists can help doctors and their diabetic patients but most of the former do not know that, they have not been taught that, and there are too many who see dentists trying to ‘muscle in’ on what is their treatment area. Dentists need to change that and achieve a paradigm shift in thinking with doctors to meet the calls for better interprofessional co-operation in care [23,24].
Defining risk factors for doctors.
The medical gold standard for diabetic monitoring is the serum level of HbA1c, a two to three month retrospective measure. This may be recorded as percentage levels that should be maintained below 6.5%, green on the traffic light method that has been introduced [25,26]. There is an amber band for 6.5 to 8.5% and a red band for greater than 8.5%. More recently these values have been expressed in either mmol/mol or mmol/litre (Table
1). However, previously determined individual targets could be more appropriate for some people with diabetes, particularly those who are frail or lack awareness of hypoglycaemia [27].
| percentage | < 6> | 6.5 – 8.5 | 8.5> |
| mmol/mol | < 48> | 48 – 69 | 69 > |
| mmol/L | < 7> | 7.8 – 10.9 | 10.9 > |
| Risk factor | Low, green | Moderate, amber | High, red |
Table 1: HbA1c levels and medical risks
Defining risk factors for dentists.
Various indices of periodontal health have been described. The measure of choice is the World health Organisation’s Community Periodontal Index of Treatment Need (CPITN) [28]. The mouth is divided into sextants, right and left molars and bicuspids, and incisors and canine teeth for each jaw. The maximum score for each sextant is recorded using the following general guidelines [25,26]:
4* Root furcation involvement or severe periodontal breakdown with an increased risk that teeth will require extraction. The maximum sextant score gives a periodontal risk factor using the traffic light system,0,1,or 2, green, 2* or 3, amber, and 4 0r 4* as red (Table 2). A pro forma has been developed for people living with diabetes to record their results and share them with their respective professional advisors (Table 3)25. This form is freely downloadable at www.chooseabrush.com.
| Highest sextant score | 0 or 1 or 2 | 2* or 3 | 4 or 4* |
| Risk factor | Low, green | Moderate, amber | High, red |
Table 2: Periodontal risk factor
Table 3:
MY DIABETES RESULTS FOR 20……..
NAME…………………………………………………DOB…………
Doctors – HbA1c, this should be below 6.5%
Risk Factor: less than 6.5% low; 6.5-8.5%, medium; 8.5% or more high, or
Less than 48mmol/mol,low;48-70mmol/mol,medium; 70mmol/mol or more,high
Less than 7.8mmol/l, low; 7.8-10.9 mmol/L, medium: more than 10.9 mmol/L high
Date HbA1c……………… Risk level…………
Previous results
Date HbA1c……………… Risk level…………
Dentists: The Basic periodontal examination
Date………………….. Highest score……..
Risk Factor 0,1,2 low; 2*-3 medium; 4 or 4* high
Previous results
Date………………….. Highest score……..
Risk Factor 0,1,2 low; 2*-3 medium; 4 or 4* high
Notes. These numbers range from 0 to 4*. The maximum score in each sextant is recorded.
2* Pockets of less than 3.5mm. Presence of sub-gingival calculus indicating a need for professional mechanical plaque removal.
4* Root furcation involvement or severe periodontal breakdown with an increased risk that teeth will require extraction.
© Dr C Turner, 2022, 2024. Reference: Brit dent J 233: 1, 2022.
See www.chooseabrush.com to down load this form
Doctors need to understand basic facts about periodontitis and record which of their patients is receiving dental care and advise those who are not that they are at greater risk of developing PD and that when PD is treated their blood sugar levels can be better controlled [29,30].
Dentists should revise their medical history questionnaire [31] to include questions about type 1 or type 2 DM. What medications are being taken because some type 2 diabetics do need insulin injections in addition to oral medication. and about hypo or hyper glycaemic episodes requiring hospitalisation. They may have a medical emergency to deal with.
However, the medical gold standard for diabetic monitoring is the glycated haemoglobin level, the HbA1c. So, the HbA1c level is a most important addition to the medical history. Each patient may know, or you may have to ask their doctor.
In our recent study, asking this question in general dental practice these are the results [32]:
Most patients, 84 per cent were type 2. Analysing their HbA1c results showed that 40 per cent were in the green zone, 20 per cent amber, 12 per cent red and 28 per cent did not know. The study also identified 9 per cent of patients who were not attending for annual review by their doctors. The importance here is that as the HbA1c increases, bringing PD under control becomes harder.
Fortunately, periodontitis is both a treatable and preventable disease with good clinical outcomes when detected at an early stage. Prevention depends on daily efficient and effective plaque control by patients33. When plaque is left in situ for 7 to 10 days inflammation results [11]. In relation to the other costs of care for the main diabetic complications, dental treatment is relatively cheap and can be cost-effective.
Where these is bone loss between teeth limited and gingivae the most efficient way to remove plaque is by using interdental brushes. These are made in a variety of diameters by different manufacturers some of whom have a limited size range [34]. For ideal results in individual prescription for the correct diameter brush for each space is essential as in one study every pattern of bone loss and therefore brush diameter requirement was individual [33].
When few sizes are suggested, plaque will always be left behind contributing to the bacteriological load, periodontal disease will continue and diabetic complications are less likely to be limited.
PD is not the sixth complication of DM. It modifies and modulates the severity of diabetic complications. This means that both diseases should be treated concurrently and that dentists and their teams have a very important role to play together with doctors.
The glycated haemoglobin results, HbA1c are essential for dentists. The higher the score the more difficult it is to control periodontal disease.
Risk results need to be shared between doctors and dentists. A form has been developed for patients themselves to show their respective professional advisors.
This can be downloaded at www.chooseabrush.com.
Dentists need to be more proactive, teach and work with doctors who may not know about the increased risk that their patients living with DM have for PD.
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."
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
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.
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
