AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/2692-9406/171
Assela Regional veterinary Laboratory, Assela, Oromiya, Ethiopia.
*Corresponding Author: Dereje Fufa, Assela Regional veterinary Laboratory, Assela, Oromiya, Ethiopia.
Citation: Tesfaye Belachew and Dereje Fufa, (2023), Bacterial Isolation and Identification from Bovine Mastitis and Their Pattern of Anti-Microbial Susceptibility Test in Selected Districts of North Shoa and Oromia Special Zone Surrounding Finfinne, Central Ethiopia, J. Biomedical Research and Clinical Reviews. 8(6); DOI:10.31579/2692-9406/171
Copyright: © 2023, Dereje Fufa. 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: 08 December 2023 | Accepted: 15 December 2023 | Published: 22 December 2023
Keywords: mastitis; prevalence; risk factors; antimicrobial
A cross-sectional study was carried out from January 2023 to February 2023 to study the prevalence of bovine mastitis (Clinical and sub –clinical), risk factors, to isolate and identify major pathogens and to make antimicrobial susceptibility test on the isolates on cross breed lactating cows which kept under intensive farming /husbandry/ system found in Barek and Sululta town. A total of 200 lactating cows examined 66 from Sululta , 71 from Wuchale and 63 from Debre libanos for mastitis by screening test/California Mastitis Test/ for sub clinical and udder observation and palpation for clinical mastitis from 9 kebeles which found in sululta,Wuchale and Debre libanos . The overall prevalence of mastitis was 57 (28.5%), where lower in Sululta and Debrelibanos districts 16(24.24) and 15(23.80) respectively and higher in Wuchale distirict 26(36.61) by clinical and sub clinical type of mastitis. From cultured samples, the bacteria genera species and isolated were as in with high prevalence were Staphylococcus intermidius 35(71.43), Staphylococcus aureus 6(12.25),E.coli 1(2.04) .Coryne bacterium (6.12%) and Bacillus cereus 4(8.13).From currently tested few isolates using selected antimicrobial agents, all susceptible for Chloramphenicol and Gentamycin except one each isolates of S.aureus and for both which shows intermediate. Similarly most of the isolates susceptible to Erythromycin and Amoxicillin except some isolates of Staphylococcus aureus, and bacillus cereus. However, high resistance was observed by most of isolates to Penicillin and tetracycline.Those cows with different lactation stage and farming system revealed significant difference (p<0.05) in prevalence of mastitis. The prevalence of both age and parity by risk factors were insignificance (P>0.05), however, there was significance difference between semi intensive and extensive farming system (P<0.05). Prevalence of mastitis, particularly, the subclinical one could bring about major economic losses in dairy cows without notice as result of reduced milk production, poor growth or mortality of suckling calves and dam health.. The resistance to penicillin and tetracycline were observed with poor efficacy may be due to prolonged and indiscriminate usage these antimicrobials in the area so that Chloramphenicol, Gentamycin and Erythromycin could be the drugs of choice in the present study.
Mastitis is a complex and multi factorial disease, the occurrence of which depends on variables related to the animal, environment and pathogen [1]. Among the pathogens, bacterial agent is the most common one, the greatest share of which resides widely distributed in the environment of dairy cows, hence a common threat to the mammary gland [2]. Mastitis induced via pathogenic microorganisms that generally come from two sources, either environmental exposure of teat to contaminated environment, or the animal itself. Staphylococcus aureus and Streptococcus agalactiae which are predominant pathogens to cause bovine mastitis) that comprises contagious bacteria causing mastitis [3, 1].
Mastitis can be classified as clinical or subclinical depending on the presence or absence of clear clinical signs. Clinical cases of mastitis are illustrated by the presence of one or more of symptoms such as abnormal milk, udder swelling and systemic signs including elevated temperature, lethargy and anorexia [3]. Mild clinical mastitis causes flakes or clots in the milk, whereas severe cases are associated with hot, swelling and discoloration of the udder, as well as abnormal secretion. Severe clinical mastitis can also exhibit systemic reactions, such as fever and loss of appetite. The duration of infection further classifies mastitis acute or chronic manifestations, where a sudden onset defines acute cases and an inflammatory process that lasts for months and results in progressive development of fibrous tissue [4] characterizes chronic mastitis.
Mastitis can exist in the absence of visible signs of infection, and is then referred to as subclinical mastitis. It is the most prevalent form of mastitis [5]. Sub clinical mastitis are those in which no visible appearance of changes in the milk or udder, but milk production decreases, bacteria are present in the secretion and composition is altered. For every case of clinical mastitis there are 20-40 times as many cases of sub clinical mastitis [3]. The current standard method of detecting subclinical mastitis is to measure somatic cell count (SCC). Other inflammatory parameters, such as electrical conductivity, lactose, lactate dehydrogenase, acute phase proteins, etc, have been proposed as indicators of subclinical mastitis, and some have the potential of being adapted to in-line use [6].Mild cases of clinical mastitis (abnormal secretion only)may not require treatment; however, all clinical mastitis episodes accompanied by an abnormal gland or systemic signs of illness should be treated with antimicrobial agents given by intra mammary infusion (all cases) and parenterally (selected cases). Acute and peracute mastitis cases require also supportive therapy (fluid and electrolytes) and non-steroidal anti-inflammatory a gents NSAIDs [7].
The cure rate after antimicrobial treatment of clinical mastitis is very variable due to both cow and bacterial factors such as parity of the cow, chronicity of the infection and bacterial genotype [8]. To approach appropriate treatment and control measure, it is important to perform antibiotic susceptibility test on relevant and most frequently used antimicrobials. Currently, in Ethiopia, including the study area, the information on prevalence and distribution of mastitis and the sensitivity to commonly used antimicrobials for treatment of mastitis is scarce.
Improvements of the productivity of livestock sector by controlling some of the major infectious disease, has received little attention in the country, especially, mastitis, the common problem of dairies that is known by an inflammation of the mammary gland is the leading one, that can contribute to reduce, milk production [9].It is primarily resulting from an invasion of mammary tissues by pathogenic microorganisms through the teat canal resulting in physical, chemical, pathological changes in glandular tissues and milk. Evidence to date shows that affected dairy cows may loss 15% of their production and the affected quarter a 30% reduction in productivity [10]. There for the objective of the study was:
Isolations and Identifications of pathogenic bacterial from bovine mastitis and their pattern of anti-microbial susceptibility test.
2.1. Study Area
Sululta District is among one of the six districts found in Oromia special zone surrounding Addis Ababa, Oromia Regional State. It lies between 390 30‘N Latitude and 380 30' and 390 00 E longitude. It is located 40 km north west of Addis Ababa. The topography of Suluta is undulated with altitude ranging between 1600 and 3318m.a. s. l. The pattern of rainfall in the area is a bi-modal and ranges from 834 to 1440 mm. The short rainy season is between February and March while the long rainy season is between June and September. According to the Sululta Livestock Resource Development and Health office, the total cattle population of the district for the year 2011 was 210,211 heads.
Wuchale district is located at the 9º17'N-9º48'N latitude and 38º45'E-39º13'E longitude; 78 Km from Addis Ababa, the capital city of Ethiopia, and 34 Km from Fiche, the capital city of north shewa zone. The district has three major administrative towns as MukeTuri (district capital), Wobori, and Gimbichu. The highest elevation of the district is 2880m, the lowest is 1200 m, and the average elevation is 2412 m above sea level.
Debre Libanos District is located in 38o 58’ 33”E longitude and 9o 63’ 75’’N latitude with altitude ranging from 1500 to 2700 m.a.s.l. For Debre Libanos the maximum and minimum annual temperature is 23 0C and 15 0C, respectively. Its main rainy season occurs between May and September and the dry season lasts from October to April. Clay and sandy soils are the major soil types of the districts. In the district agricultural production is characterized by a mixed crop-livestock production system [11].
2.2. Study Animals
The study populations were lactating cows breeds of cattle (Holstein Friesian (HF) and Cross breed (HF x Local) in selected dairy farms in the study area. The animals were managed under Intensive, semi intensive and extensive management system. They were often provided with some supplementary diet in addition to the natural pasture and agricultural by products and some were maintained usually in separate stalls, a short distance from each other in a house. Pre-milking and post-milking hygienic procedures, such as udder washing and drying, was frequently practice.
2.3. Study design
A cross-sectional study was carried out from January to April 2023 to study the prevalence of bovine mastitis (Clinical and sub –clinical), risk factors, to isolate and identify major pathogens and to make antimicrobial susceptibility test on the isolates on cross breed lactating cows which kept under intensive farming /husbandry/ system found in Sululta, Wuchale and Debre libanos Districts.
2.4. Sampling methods and determination of sample size
Simple random sampling were carried out and the sample size of the study was determined based on sample size determination method as described by [12] with a 95% confidence interval and 5
5.1 Prevalence
A total of 200 lactating cows examined 66 from Sululta , 71 from Wuchale and 63 from Debre libanos for mastitis by screening test/California Mastitis Test/ for sub clinical and udder observation and palpation for clinical mastitis from 9 kebeles which found in sululta,Wuchale and Debre libanos (Table 1 ).The overall prevalence of mastitis was 57 (28.5%), where lower in Sululta and Debrelibanos districts 16(24.24) and 15(23.80) respectively and higher in Wuchale distirict 26(36.61) by clinical and sub clinical type of mastitis (Table 1).
Table 1- prevalence of bovine mastitis by districts
Out of 800 quarters examined during the study period 72(9.00%) were positive for mastitis while 13 (1.62%) blind (table 2).
Table 2: Quarters level examined during the study period
Those cows with different lactation stage and farming system revealed significant difference (p<0>0.05), however, there was significance difference between semi intensive and extensive farming system (P<0>
From the test results in each districts S.epidermis higher in number and E.coli was lower than all isolate as shown in the table 4.
Table 3: The prevalence of mastitis within the considered risk factors
Table 4: Summary of test result by percentage and by districts
From cultured samples, the bacteria genera species and isolated were as in with high prevalence were Staphylococcus intermidius 35(71.43), Staphylococcus aureus 6(12.25),E.coli 1(2.04) Coryne bacterium 3(6.12%) and Bacillus cereus 4(8.13) as shown in table 5 below.
Table 5: Overall prevalence of pathogen isolates causing bovine mastitis in the study area
Staphylococcus aures were highliy susceptibility (100%) to Oxacillin (OX) ,Kanamycin(K),Gentamicin(CN), Chloramphenicol (C) ,Ciprofloxacilin (Cip) Clindamycim (CD), Cefoxitin (FOX) and Vancomycin (VA) and resistant to PenicillinG(P) ,Amoxicillin(AX) and Ampicillin(AMP) as clearly explained in table 6
Table 6: Summary of Resistances and susceptibility of Staphylococcus aures bacteria by percentage
Staphylococcus epidermis were Susceptible(100) to Kanamycin (K), Gentamicin (CN) ,Streptomycin(S) ,Cefoxitin(FOX) ,Vancomycin(VA) Sulphamethaxazole-Trimethoprim(SXT25) ,Chloramphenicol(C) ,Ciprofloxacilin(Cip) and Clindamycim(CD) and resistant (100) to Amoxicillin(AX) (table 7)
Table 7: Summary of Resistances and susceptibility of Staphylococcus epidermis bacteria by percentage
E.coli was resistant to Ampicillin (AMP) and almost susceptible the other drug used for the tests as shown in table 8 below.
Table 7: Summary of Resistances and susceptibility of E.coli bacteria by percentage
The overall prevalence of mastitis in the present study was 28.50%), But this finding was lower than the 89.5% report of [13] in salale, north shoa. This could be due to difference in management system in that alternative free ranging management within door keeping system is mostly applied in the present study area. Environmental bacterial mastitis were higher in prevalence, due to poor housing facilities which predispose the accumulation of faeces on cows which will increase the rate of exposure of the teats and udder to the pathogens. Exposure to environmental Streptococci may occur during milking, between milking and during dry period [7].
From cultured samples, the bacteria genera species and isolated were as in (table 4) with high prevalence were as in (table 5) with high prevalence were Staphylococcus intermidius 35(71.43), Bacillus cereus 4(8.13), Staphylococcus aureus 6(12.25), Coryne bacterium (6.12%) and E.coli 1(2.04) from mastitis positive animal in present study shows the higher contributions of microbial in the cause of mastitis in the area.
Although Staphylococcus intermidius 35(71.43), this higher level occurrence might be due to the organism’s behavior which is adapted to survive in the udder and usually establishes a mild subclinical infection of long duration from which it shed in milk facilitating transmission to healthy animals mainly during milking [7] and the predominant pathogens isolated in this study, it was lower than the 13% reported [13]. From cultured samples, the bacteria genera species and isolated were as in with high prevalence were Staphylococcus aureus (52.62%), E.coli (10.52%) Staphylococcus intermidius., Diplocuccus spps and Staphylococcus hycus (5.26 %) and Corynebacterium bovis (3.50%) were lower than the 38.4 and 23.2% report of [13] irrespective of the agent.
From currently tested few isolates using selected antimicrobial agents, all susceptible for Chloramphenicol and Gentamycin except one each isolates of S.aureus and for both which shows intermediate. Similarly most of the isolates susceptible to erytomycine except some isolates of Staphylococcus aureus, and bacilles cereus. However, high resistance was observed by most of isolates to Penicillin and tetracycline which is agree with finding of [23] in and around Asella town
The study attempted to prevalence of bovine mastitis by considering associated risk factors in north shoa zone, isolates and determines antibiotic susceptibility profiles of pathogens involved in bovine mastitis using clinical sing, CMT, bacteriology and invitro susceptibility test. Prevalence of mastitis, particularly, the subclinical one could bring about major economic losses in dairy cows without notice as result of reduced milk production, poor growth or mortality of suckling calves and dam health. Thus, due attention should be given to increase the awareness of health management (cow-udder hygiene, milking area hygiene, milker’s hand hygiene, husbandry, tick control etc) in the area including proper antibiotic selection, dosage and frequency of administration of drugs.
Based on this concluding remark the following points can be recommended:
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.
