AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/2641-0419/251
1 Department of Cardiology, Van Training and Research Hospital. 65300 Van, Turkey
2 Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
*Corresponding Author: Mujdat AKTAS, MD. Department of Cardiology, Prof. Dr. Cemil Tascioglu City Hospital İstanbul, 34384 Turkey.
Citation: Abdulcebbar Sipal, Mujdat Aktas, Tayyar Akbulut, Faysal Saylik (2022) Impact of Covıd-19 Pandemıc on Severe Ventrıcular Arrhythmıa and Icd Therapy. J. Clinical Cardiology and Cardiovascular Interventions, 5(6); DOI:10.31579/2641-0419/251
Copyright: © 2022 Mujdat AKTAS, 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: 03 February 2022 | Accepted: 22 April 2022 | Published: 29 April 2022
Keywords: covıd‐19; ventricular arrhythmia; ımplantable cardioverter-defibrillator
BACKGROUND AND OBJECTIVES: The regular clinical follow-up of the patient with the implantable cardioverter-defibrillator (ICD) device was seriously affected by the COVID-19 outbreak. Due to the high risk of contamination, patients didn’t admit to the clinics for the ICD device control. It has been observed that arrhythmic events increased during the COVID-19 outbreak. In this study, we aimed to investigate the frequency of severe ventricular arrhythmias and ICD device therapy in COVID-19 patients with ICD.
METHODS: In this single center-observational study, we assessed severe ventricular arrhythmias and ICD therapies by analyzing recorded data of 33 patients (24 males, 72.7%) 3 months before and after getting COVID-19 during the COVID-19 pandemic in Van, Turkey, between 15 August 2020 and 15 January 2021.
RESULTS: Before the diagnosis of COVID-19, 6 ventricular tachycardias and 1 ventricular fibrillation episode were observed. When we analyzed the records after the diagnosis COVID-19, 17 ventricular tachycardia, and 3 ventricular fibrillation episodes were observed. Considering the ICD device therapies, 5 of these severe tachyarrhythmias were terminated by anti-tachycardia pacing (ATP) and 2 with shock therapy before the diagnosis of COVID-19. After the COVID-19, 14 of them were terminated by ATP, and 6 of them were terminated by shock therapy.
CONCLUSION: The effects of the COVID-19 pandemic, especially on ventricular arrhythmia, have not been reported sufficiently. In our study, it was observed that life-threatening ventricular arrhythmias and the ICD therapies were increased in patients with COVID-19, especially in the first month after the diagnosis of COVID-19.
Although COVID-19 (Corona Virus Disease 2019) mainly affects the lungs, extrapulmonary complications such as cardiac complications are also increasing day by day. [1] SARS-CoV2 (severe acute respiratory syndrome-coronavirus-2) infection is associated with many pro-inflammatory mediators that may play a role in the development of cardiac arrhythmia and complications. In a single-center study, the cardiac injury was observed in 19 percent of the hospitalized patients. Therefore, it is plausible that these patients have an even higher risk of cardiac arrhythmias.
Ventricular arrhythmias mostly occur in settings associated with an increased sympathetic tone, including physical activity, illness, and emotional distress. [2] Lung injury and hypoxemia caused by the SARS-CoV 2 epidemic may cause irregularity in the electrical activity of the myocardium. In addition, SARS-CoV2 can directly damage myocardial cells and the electrical conduction system of the heart. Again, COVID-19 infection can aggravate the underlying cardiovascular disease, and the release of endogenous catecholamine may disrupt the electrical activity of the myocardium due to increased anxiety.
Patients with ICD (implantable cardioverter-defibrillator) device are always at risk of life-threatening ventricular arrhythmia (VA) and sudden death. We analyzed the data of the old ICD patients to determine whether the device therapy and ventricular arrhythmia burden have increased after the diagnosis of COVID-19.
This is a single center-observational study. Patients with previously implanted ICD devices (single and dual-chamber ICD) due to systolic left ventricular dysfunction or cardiac arrest and syncope and who were positive for COVID-19 PCR (+) (Polymerase Chain Reaction) were included in this study. For this study, 50 patients' ICD device records were reviewed in the cardiology clinic. 33 patients who met the inclusion criteria were included. Data obtained from the ICD of 33 patients (24 males) who were admitted to the clinic for regular pacemaker control between August 15, 2020, and January 15, 2021, and had positive PCR results for COVID-19 were examined. The period of 3 months before and 3 months after COVID-19 PCR test positivity was examined. Ventricular arrhythmias [ventricular fibrillation (VF) or ventricular tachycardia (VT)] treated by the ICD (ATP or shock) were detected. The development of ventricular tachycardia (VT) and ventricular fibrillation (VF) after COVID-19 was the primary endpoint of this study. During the study and COVID-19 infection, the ICD device treatment protocol was not changed.
Inclusion criteria
Exclusion criteria
This study was reviewed and approved by the Ethics Committees of the Van Training and Research Hospital Van, Turkey. Also, all methods were performed in accordance with the relevant current guidelines and regulations.
All statistical analyzes were done with SAS University Edition (SAS / STAT, SAS Institute Inc, NC, USA). The 90 days following COVID-19 was compared with each of the 90-day before and after this period. The number of patients who had an arrhythmic event during the 3 months before and after the COVID-19 infection was compared using McNemar’s test. Mantel-Haenszel statistic was used to calculate the relative risk (RR) estimated for the paired data. The number of arrhythmic events was compared using the Wilcoxon-signed rank test between paired data. Kaplan-Meier survival curves (time to the first event) were reproduced and Gehan’s test for paired data was used for comparison survival curves. 90-day discharge rates over the follow-up period were estimated using a PROC GENMOD procedure (A modified Poisson regression approach to prospective studies with binary data) [3] and a generalized estimating equation was performed to account for within-subject correlation. The Loess curves with a span of 0.15 were used to illustrate the estimated 10-day periods of arrhythmic events over time. The prediction of arrhythmic event 90-day after COVID-19 by predictors was performed by using logistic regression analysis. A p-value <0>
Baseline characteristics
A total of 33 patients (24 male 72,7%); mean age was 62,4±17,7 years) were enrolled in our study. All patients were using beta-blockers. In the study, 51.5 percent of patients had an ICD implanted for primary prevention. In patients who had an ICD implanted for secondary prevention, 68,8% were implanted due to VT, 18,8 due to cardiac arrest, and 12,4 due to syncope (Table 1).
Baseline characteristics
A total of 33 patients (24 male 72,7%); mean age was 62,4±17,7 years) were enrolled in our study. All patients were using beta-blockers. In the study, 51.5 percent of patients had an ICD implanted for primary prevention. In patients who had an ICD implanted for secondary prevention, 68,8% were implanted due to VT, 18,8 due to cardiac arrest, and 12,4 due to syncope (Table 1).
| Age (mean±SD) | 62.4±17.7 |
| Gender , % | |
| Male | 72.7 |
| Female | 27.3 |
| BMI (mean±SD) | 27.6±3.05 |
| Comorbidities, % | |
| CAD | 57.6 |
| DM | 39.4 |
| HT | 66.7 |
| COPD | 9.1 |
| Cigarette smoking, % | 39.4 |
| Medications, % | |
| Diuretics | 66.7 |
| ACEI/ARB | 100 |
| ASA | 78.8 |
| Clopidogrel | 9.1 |
| Digoxin | 24.2 |
| Beta blockers | 100 |
| Amiodarone | 3 |
| Calcium channel blockers | 15 |
| ICD indication, % | |
| Primary prevention % | 51.5 |
| Secondary prevention, % | 48.5 |
| VT | 68.8 |
| Cardiac arrest | 18.8 |
| Syncope/inducible VT | 12.5 |
| LV ejection fraction, % | 36.9±10.2 |
CAD: Coronary artery disease, DM: Diabetes mellitus, HT: Hypertension, COPD: Chronic obstructive pulmonary disease, ACEI:Angiotensin-converting-enzyme inhibitors, ARB: Angiotensin receptor blockers, ASA: Acetylsalicylic acid, ICD: Implantable cardioverter-defibrillator, VT: Ventricular tachycardia, LV: Left ventricle.
Table 1: Characteristics of the Study Population (N=33)
Clinical events
Ventricular arrhythmic events were analyzed by reviewing intracardiac EGM records. When looking at the records before getting COVID-19, 7 (6 VT, 1 VF) arrhythmia episodes were detected. 5 of these arrhythmias were terminated by ATP and 2 by shock therapy. After the COVID-19 diagnosis, 20 arrhythmias (17 VT, 3 VF) episodes were detected. 14 of these arrhythmias were terminated by ATP and 6 by shock therapy (Table 2). Regarding the type of arrhythmia and the device therapy, no statistical difference was found between the groups before and after COVID-19.
Parameter | Before COVID-19 | After COVID-19 | p value |
| Arrhythmia type | |||
Ventricular tachycardia (%) Ventricular fibrillation (%) | 6/7 (85.7) 1/7(14.3) | 17/20(85) 3/20(15) | NS NS |
| Termination (%) | |||
| ATP | 5/7(71.4) | 14(70) | NS |
| Shock | 2/7(28.6) | 6(30) | NS |
COVID-19: Coronavirus disease 19, ATP: Antitachycardia pacing, NS: Not Statistically Significant
Table 2: Characteristics of Ventricular Arrhythmias and Device Therapies
Although none of 33 patients had VA episodes in 30 days prior to COVID-19, 14 (42,4%) of 33 patients had at least one arrhythmia episode treated by the ICD device in the first 30 days after COVID-19. Arrhythmias were detected in 7 patients both before and after the COVID-19. The first severe VA after COVID-19 was seen on the 6th day. Serious arrhythmic events increased cumulatively and occurred on average 21,8±13,7 days post COVID-19. Kaplan-Meier curve analysis displayed that arrhythmic events after COVID-19 period were statistically significantly higher than before COVID-19 infection (Log-rank p-value <0>
Comparing the incidence of arrhythmia in 3 months before and after COVID-19, it was seen that the risk of tachyarrhythmia increased 2.86 times, which is statistically significant according to paired analysis (95% confidence interval [CI] 1.57 to 5.19, p <0>
Compared with 90 days before covid-19, the risk of ventricular arrhythmias for the 90 days after covid-19 increased 9-fold (95% CI 2.44 to 33,2, p-value: 0.001). Compared between 90 days before covid-19, the risk of ventricular arrhythmias for the 90 days after covid-19 increased 3,6-fold (95% CI 1.62 to 8, p-value: 0.003) (Figure 2). According to the univariate logistic regression analysis adjusted for demographic and clinical parameters, demonstrated no significant relationship with arrhythmic events after COVID-19.
A total of 33 patients (24 male 72,7%); mean age was 62,4±17,7 years) were enrolled in our study. All patients were using beta-blockers. In the study, 51.5 percent of patients had an ICD implanted for primary prevention. In patients who had an ICD implanted for secondary prevention, 68,8% were implanted due to VT, 18,8 due to cardiac arrest, and 12,4 due to syncope (Table 1).
| Age (mean±SD) | 62.4±17.7 |
| Gender , % | |
| Male | 72.7 |
| Female | 27.3 |
| BMI (mean±SD) | 27.6±3.05 |
| Comorbidities, % | |
| CAD | 57.6 |
| DM | 39.4 |
| HT | 66.7 |
| COPD | 9.1 |
| Cigarette smoking, % | 39.4 |
| Medications, % | |
| Diuretics | 66.7 |
| ACEI/ARB | 100 |
| ASA | 78.8 |
| Clopidogrel | 9.1 |
| Digoxin | 24.2 |
| Beta blockers | 100 |
| Amiodarone | 3 |
| Calcium channel blockers | 15 |
| ICD indication, % | |
| Primary prevention % | 51.5 |
| Secondary prevention, % | 48.5 |
| VT | 68.8 |
| Cardiac arrest | 18.8 |
| Syncope/inducible VT | 12.5 |
| LV ejection fraction, % | 36.9±10.2 |
CAD: Coronary artery disease, DM: Diabetes mellitus, HT: Hypertension, COPD: Chronic obstructive pulmonary disease, ACEI:Angiotensin-converting-enzyme inhibitors, ARB: Angiotensin receptor blockers, ASA: Acetylsalicylic acid, ICD: Implantable cardioverter-defibrillator, VT: Ventricular tachycardia, LV: Left ventricle.
Table 1: Characteristics of the Study Population (N=33)
Clinical events
Ventricular arrhythmic events were analyzed by reviewing intracardiac EGM records. When looking at the records before getting COVID-19, 7 (6 VT, 1 VF) arrhythmia episodes were detected. 5 of these arrhythmias were terminated by ATP and 2 by shock therapy. After the COVID-19 diagnosis, 20 arrhythmias (17 VT, 3 VF) episodes were detected. 14 of these arrhythmias were terminated by ATP and 6 by shock therapy (Table 2). Regarding the type of arrhythmia and the device therapy, no statistical difference was found between the groups before and after COVID-19.
Parameter | Before COVID-19 | After COVID-19 | p value |
| Arrhythmia type | |||
Ventricular tachycardia (%) Ventricular fibrillation (%) | 6/7 (85.7) 1/7(14.3) | 17/20(85) 3/20(15) | NS NS |
| Termination (%) | |||
| ATP | 5/7(71.4) | 14(70) | NS |
| Shock | 2/7(28.6) | 6(30) | NS |
COVID-19: Coronavirus disease 19, ATP: Antitachycardia pacing, NS: Not Statistically Significant
Table 2: Characteristics of Ventricular Arrhythmias and Device Therapies
Although none of 33 patients had VA episodes in 30 days prior to COVID-19, 14 (42,4%) of 33 patients had at least one arrhythmia episode treated by the ICD device in the first 30 days after COVID-19. Arrhythmias were detected in 7 patients both before and after the COVID-19. The first severe VA after COVID-19 was seen on the 6th day. Serious arrhythmic events increased cumulatively and occurred on average 21,8±13,7 days post COVID-19. Kaplan-Meier curve analysis displayed that arrhythmic events after COVID-19 period were statistically significantly higher than before COVID-19 infection (Log-rank p-value <0>
Comparing the incidence of arrhythmia in 3 months before and after COVID-19, it was seen that the risk of tachyarrhythmia increased 2.86 times, which is statistically significant according to paired analysis (95% confidence interval [CI] 1.57 to 5.19, p <0>
Compared with 90 days before covid-19, the risk of ventricular arrhythmias for the 90 days after covid-19 increased 9-fold (95% CI 2.44 to 33,2, p-value: 0.001). Compared between 90 days before covid-19, the risk of ventricular arrhythmias for the 90 days after covid-19 increased 3,6-fold (95% CI 1.62 to 8, p-value: 0.003) (Figure 2). According to the univariate logistic regression analysis adjusted for demographic and clinical parameters, demonstrated no significant relationship with arrhythmic events after COVID-19.
To the best of our knowledge, this is the first study to report the effect of COVID-19 on severe ventricular arrhythmia in patients with ICD devices. In many studies, it has been determined that cardiac arrhythmias increase in viral infections. Arrhythmia and conduction system disease are not early or common symptoms of COVID-19 disease, and most symptoms in COVID-19 disease are associated with the respiratory system.[4] Sinus tachycardia is the most common arrhythmia, and sinus tachycardia is a physiological response secondary to viral infection, and arrhythmias other than sinus tachycardia have been reported frequently and are typically caused by viral myocarditis affecting the cardiac conduction system.[5] In particular, relatives of the current COVID-19 virus such as SARS and MERS tend to have many arrhythmias, including sinus bradycardia.[6,7] Arrhythmias in COVID-19 disease can also occur due to side effects of drugs, hypoxia and lung disease, and myocarditis. Sinus bradycardia is one of the most common arrhythmias and can last for up to 2 weeks. [8]
In a study performed by Catherine J. O'Shea et al. a 32% reduction was observed in arrhythmias needing device therapy due to social isolation during the pandemic period and the decrease in real-life stress factors. However, the COVID-19 status of the patients was not examined in this study. In our study, only patients with COVID-19 were included, and when the device records of the patients before and after COVD-19 were compared, a statistically significant increase was observed in ventricular arrhythmia and device therapy. In addition, in a study conducted by Biagio Sassone et al., it was objectively measured that the patients decreased their physical activities due to isolation during the pandemic period. [9] In this study, a 25
The effects of the COVID-19 pandemic, especially on ventricular arrhythmia, have not been reported sufficiently. In our study, it was observed that life-threatening ventricular arrhythmias and device therapy increased in patients with COVID-19, especially in the first month after COVID-19. Cardiovascular symptoms of COVID-19 can range from mild troponin and BNP elevation to fulminant myocarditis, life-threatening ventricular arrhythmia, and refractory shock. Close hemodynamic and electrocardiographic follow-up should be performed for all patients with COVID-19, especially if they are under COVID-19 treatment.
The small number of patients is the main limitation of our study. Results from this study should be confirmed by future prospective studies or records.
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.
