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Research Article | DOI: https://doi.org/10.31579/2690-4861/911
1Second Degree Specialist in Psychiatry. Master in satisfactory longevity. Assistant teacher. University of Medical Sciences. “Camilo Cienfuegos” General Hospital. Sancti Spiritus. Cuba.
2First Degree Specialist in Psychiatry and Family Medicine. Assistant professor. University of Medical Sciences. “Camilo Cienfuegos” General Hospital. Sancti Spiritus. Cuba.
3First Degree Specialist in Psychiatry and Family Medicine. Instructor teacher. University of Medical Sciences. “Camilo Cienfuegos” General Hospital. Sancti Spiritus. Cuba
4First Degree Specialist in Psychiatry and Family Medicine. Assistant professor. University of Medical Sciences. “Camilo Cienfuegos” General Hospital. Sancti Spiritus. Cuba.
5First Degree Specialist in Internal Medicine. Instructor Professor. University of Medical Sciences. “Camilo Cienfuegos” General Hospital. Sancti Spiritus. Cuba.
6PhD in Medical Sciences. Master in Natural and Bioenergetic Medicine. Second Degree Specialist in Family Medicine and Physical Medicine and Rehabilitation. Full Professor. Assistant Researcher. University of Medical Sciences of Sancti Spiritus, Cuba. Multi-profile Clinic, Luanda, Angola.
*Corresponding Author: Juan Carlos Mirabal Requena, PhD in Medical Sciences. Master in Natural and Bioenergetic Medicine. Second Degree Specialist in Family Medicine and Physical Medicine and Rehabilitation. Full Professor. Assistant Researcher. University of Medical Sciences o
Citation: Berkis M. Hernández, Lidiver M. Calderón, Bonachea Sánchez BL, Ederlys M. García, Nailanys P. Matos, et al, (2025), Development of A Prognostic Stratification Scale for Cardiovascular Death in Patients with Schizophrenia, International Journal of Clinical Case Reports and Reviews, 31(5); DOI:10.31579/2690-4861/911
Copyright: © 2025, Juan Carlos Mirabal Requena. 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: 11 December 2025 | Accepted: 19 December 2025 | Published: 26 December 2025
Keywords: schizophrenia; cardiovascular disease; risk stratification; prognosis; Cuba; premature mortality
Patients with schizophrenia have a 15–20-year reduced life expectancy compared to the general population, with cardiovascular diseases being the leading cause of death. Conventional cardiovascular risk scales (Framingham, SCORE, REGICOR) have significant limitations as they do not include specific variables for mental illness and are not validated for the Cuban socioeconomic and healthcare context.
Objective: To develop and validate a prognostic model and cardiovascular death risk stratification scale specific for patients with schizophrenia in Sancti Spíritus province, Cuba.
Methods: An observational analytical study for prognostic model development with prospective cohort design was designed. 350 patients with schizophrenia diagnosis (ICD-10) from "Camilo Cienfuegos" Provincial General Hospital in Sancti Spíritus will be recruited, with 24-month prospective follow-up. Study variables will include demographic dimensions (age, sex, disease evolution time), clinical (BMI, blood pressure, smoking, sedentary behavior), psychiatric (schizophrenia subtype, antipsychotic treatment), hemochemical parameters (lipid profile, blood glucose, creatinine) and socio-environmental factors (social support, family functioning, educational level). Statistical analysis will follow a sequential strategy: descriptive analysis, univariate analysis (Chi-square, t-Student tests), survival analysis using Cox regression to identify independent prognostic factors, prognostic model development based on Beta coefficients, scoring scale elaboration, and internal validation through bootstrapping with 1,000 resamples.
Expected results: Based on reviewed literature, independent prognostic factors anticipated include: age > 50 years (expected RR: 2.1; 95%CI: 1.8-2.5), schizophrenia evolution time > 10 years (RR: 1.8; 95%CI: 1.5-2.2), use of high metabolic risk atypical antipsychotics (RR: 1.5; 95%CI: 1.2-1.9), HDL cholesterol < 40 mg/dL (RR: 2.2; 95%CI: 1.8-2.7), and low family social support (RR: 1.9; 95%CI: 1.6-2.3). The final model will include 6-8 significant predictor variables (p < 0.05) and demonstrate adequate discriminatory capacity (Harrell's C-index > 0.75) and calibration.
Conclusions: The development of a specific scale for cardiovascular risk stratification in patients with schizophrenia is methodologically feasible and addresses an unmet clinical need in the Cuban healthcare system. The resulting tool will allow identification of high-risk subpopulations requiring intensive preventive interventions and optimize health resource allocation.
Cardiovascular diseases (CVD) constitute one of the main challenges for health systems globally. According to World Health Organization reports, CVD were responsible for approximately 19.8 million deaths in 2022, representing a significant increase compared to the 12.4 million registered in 1990[1]. In the Cuban context, this problem acquires particular relevance when analyzing specific mortality rates. During 2022, Cuba reported an adjusted CVD mortality rate of 129.6 per 100,000 inhabitants, with a crude rate of 296.7[2]. The province of Sancti Spíritus, the geographical scope of this study, showed even higher indicators, with a crude mortality rate of 359.6 and an adjusted rate of 148.1 per 100,000 inhabitants[2].
Concurrently, schizophrenia represents a severe mental health condition affecting approximately 1% of the world population³. Patients diagnosed with this disorder present a particularly high vulnerability for developing medical comorbidities and experiencing premature mortality. Robust epidemiological studies have demonstrated that patients with schizophrenia have a 2-3 times greater risk of dying than the general population⁴. While initially this excess mortality was attributed to external causes such as suicides, homicides, or accidents, contemporary evidence identifies cardiovascular diseases as the leading cause of death in this population⁵.
The association between schizophrenia and CVD has been the subject of growing scientific interest in recent decades. Recent systematic reviews and meta-analyses have confirmed this relationship, particularly for coronary heart disease and cerebrovascular disease⁶. An emerging hypothesis postulates that schizophrenia per se constitutes an independent risk factor for CVD, not completely explainable by traditional cardiovascular risk factors, lifestyles, or medication iatrogenesis⁷. This intrinsic vulnerability could be mediated by alterations in neuroendocrine systems, chronic inflammatory processes, autonomic dysfunction, and shared genetic factors⁸.
In routine clinical practice, cardiovascular risk stratification in patients with schizophrenia is predominantly performed using scales designed for the general population, such as Framingham, SCORE, REGICOR, or WHO charts⁹. However, these tools have fundamental limitations when applied to this specific population. Firstly, they were developed and validated in cohorts that systematically excluded patients with severe mental illness¹⁰. Secondly, they do not incorporate specific variables relevant to schizophrenia, such as the type and duration of antipsychotic treatment, particular symptomatic characteristics, or specific psychosocial dimensions¹¹. Finally, these scales were calibrated for populations with epidemiological, genetic, and socioeconomic characteristics different from those of the Cuban population¹².
In the international context, some specific instruments for populations with severe mental disorders have been developed. The PRIMROSE model developed in the United Kingdom stands out, which includes variables such as prescription of antipsychotics, antidepressants, and social deprivation¹³. However, its applicability in the Cuban health system is limited due to structural differences in the organization of health services, distinct epidemiological profiles, and differential availability of diagnostic and therapeutic resources¹⁴.
In Cuba, care for patients with schizophrenia is governed by treatment guidelines and action protocols that, unfortunately, prioritize the management of psychotic symptoms over cardiovascular prevention¹⁵. Risk stratification is performed using tools extrapolated from other regions, without evidence of their validity in this specific population. This care gap becomes more relevant considering that, according to WHO data, deaths attributed to schizophrenia in Cuba reached 68 in 2020, placing the country 12th worldwide in terms of disease burden from this disorder¹⁶.
The creation of a specific cardiovascular risk stratification tool for patients with schizophrenia, adapted to the Cuban context, would allow not only the early identification of individuals with greater vulnerability but also the optimization of limited health resource allocation and guide personalized preventive interventions. This study is based on the premise that incorporating specific clinical, psychiatric, and socio-environmental variables of this population will significantly improve predictive accuracy compared to conventional scales.
Therefore, the general objective of this research is to develop and validate a prognostic model and a scale for the stratification of cardiovascular death risk in patients with schizophrenia from the province of Sancti Spíritus, Cuba. To address this, we proceeded to describe the baseline characteristics of the study population and the variables related to cardiovascular risk; identify prognostic factors that allow estimation of the probability of cardiovascular death; then determine a prognostic model of cardiovascular mortality based on the identified predictors; to develop a risk scale for prognostic stratification and proceed to validate the obtained risk scale.
Study design: An observational analytical study for the development and validation of a prognostic model, with a prospective cohort design, was designed. This design is appropriate for the stated objectives, as it allows establishing temporal relationships between predictor variables and the outcome of interest, as well as calculating association measures such as relative risks. The study will follow the recommendations of the TRIPOD statement (Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis) to guarantee methodological quality and transparency in reporting¹⁷.
Setting and period: The study will be developed at the "Camilo Cienfuegos" Provincial General Hospital in Sancti Spíritus, Cuba, and in the outpatient psychiatry services associated with this institution. This hospital is the main referral center for mental health in the province, serving an approximate population of 465,000 inhabitants. The recruitment period will extend from January 2024 to December 2025, with a prospective follow-up of 24 months for each included patient. The study completion is planned for December 2027, allowing for complete data analysis and model validation.
Population and sample: The target population consists of approximately 1,200 patients with a diagnosis of schizophrenia (codes F20.x according to ICD-10) registered in the psychiatry services of the study setting. The sample size calculation was performed considering the following parameters: statistical power of 80%, significance level of 0.05, expected relative risk of 2.0, proportion of exposed of 40%, and event rate of 15% in the highest risk group. Using the Schoenfeld formula for proportional hazards models, a minimum sample size of 298 patients was determined. Anticipating a possible 15% loss during follow-up, the final sample size was set at 350 patients.
Inclusion criteria:
Exclusion criteria:
Study variables:
Data collection: Data collection will be performed using a structured form designed specifically for this study. This instrument will include sections for: (a) data from psychiatric and medical records; (b) structured clinical interview with the patient; (c) interview with family member or primary caregiver; (d) clinical laboratory results. Hemochemical variables will be determined in the hospital's clinical laboratory using standardized and automated methods. All blood pressure measurements will be performed following the protocol established by the Cuban Society of Arterial Hypertension, with calibrated sphygmomanometers and by trained personnel.
Ethical aspects: The study protocol was approved by the Research Ethics Committee of the University of Medical Sciences of Sancti Spíritus (Minutes No. 15/2023). Written informed consent will be obtained from all participants after a detailed explanation of the objectives, procedures, potential benefits, and risks of the study. In cases of patients with diminished capacity to consent, consent will be obtained from the legal representative as established by current Cuban legislation. Data confidentiality will be guaranteed through the use of identification codes and secure database storage. The study will be conducted in accordance with the principles of the Declaration of Helsinki and Cuban ethical regulations for research in humans.
Statistical analysis: Data analysis will follow a sequential strategy:
Data management and analysis will be performed with SPSS v.25 and R v.4.0 with the rms and survival packages.
Expected Results
Based on the exhaustive review of the literature and the epidemiological characteristics of the Cuban population with schizophrenia, the following results are anticipated:
Baseline population characteristics: A cohort of 350 patients is expected to be recruited with a sex distribution similar to that reported in previous national studies (approximately 55% male, 45?male). The anticipated mean age is 45±12 years, with a mean time since schizophrenia onset of 15±8 years. Regarding the distribution by diagnostic subtypes, a predominance of the paranoid subtype (≈60%) is expected, followed by undifferentiated (≈25%) and residual (≈15%).
Prevalence of cardiovascular risk factors: According to international literature and previous Cuban studies, a high prevalence of modifiable cardiovascular risk factors is anticipated: active smoking (≥60%), sedentary behavior (≥70%, defined as <150>
Identified prognostic factors: In the multivariate analysis using Cox regression, the following are anticipated to be identified as independent prognostic factors for cardiovascular death:
Final prognostic model: The final model is anticipated to include between 6-8 statistically significant predictor variables (p < 0>0.05). The model equation will have the form: Risk Score = Σ(βi × Xi), where βi represents the Cox regression coefficients and Xi the values of each predictor variable.
Risk stratification scale: The scale derived from the model will allow stratifying patients into three risk categories based on the total score:
Model validation: Internal validation through bootstrapping is expected to show good model performance, with an optimism-corrected Harrell's C-index >0.75, indicating adequate discriminatory capacity. The calibration plot is expected to demonstrate good agreement between predicted and observed probabilities, with a calibration slope close to 1 and a non-significant Hosmer-Lemeshow test (p>0.05).
The development of a specific scale for cardiovascular risk stratification in patients with schizophrenia represents a necessary response to an identified care gap in the Cuban health system. The expected results of this study align with findings reported in the international literature, which consistently highlight the importance of specific factors in this population, such as the type of antipsychotic, the time since illness onset, and particular psychosocial dimensions¹⁹.
The anticipated identification of time since schizophrenia onset as an independent prognostic factor reinforces the hypothesis that the cumulative burden of mental illness contributes significantly to cardiovascular risk. This finding would be consistent with previous studies that have documented a dose-response relationship between the duration of schizophrenia and all-cause mortality²⁰. Underlying mechanisms could include cumulative neurobiological effects, prolonged exposure to psychotropic medications, and progressive deterioration of psychosocial functioning.
The inclusion of socio-environmental variables, particularly family social support, constitutes a significant innovation compared to conventional cardiovascular risk scales. Scientific literature has consistently demonstrated that family functioning and social support are crucial determinants in the clinical evolution of patients with schizophrenia, influencing treatment adherence, lifestyles, and access to health services²¹. In the Cuban context, where the family traditionally plays a central role in supporting people with mental illness, this variable could have particularly high relevance.
The emphasis on low-cost hemochemical parameters widely available in the Cuban health system (such as HDL cholesterol) responds to the need to develop feasible and sustainable tools in resource-limited contexts. This approach is consistent with WHO recommendations for the development of risk assessment instruments in middle- and low-income countries²².
The potential limitations of the study deserve consideration. Firstly, the observational design prevents establishing definitive causal relationships between predictor variables and the outcome. However, the prospective nature of the cohort and adjustment for multiple confounding factors will allow robust inferences about prognostic associations. Secondly, being conducted in a single Cuban province, the generalization of the results will require external validation in other regions of the country. Nevertheless, the selection of Sancti Spíritus, with its epidemiological characteristics representative of the Cuban context, increases the likelihood that the findings will be extrapolable. Finally, possible loss to follow-up constitutes a methodological concern that will be addressed through active participant tracking and retention strategies.
The practical implications of this research are multifaceted. At the individual clinical level, the resulting scale will allow psychiatrists and family physicians to identify high-risk patients requiring intensive preventive interventions, optimize the selection of antipsychotics according to individual metabolic risk profile, and improve coordination between psychiatry and cardiology services. At the public health level, it will facilitate the efficient allocation of limited resources towards the most vulnerable population, prioritizing cost-effective interventions in high-risk subgroups. Additionally, the scale could serve as an evaluation tool in future research on preventive interventions in this population.
The scientific novelty of this study lies in several aspects: (1) It is the first development of a specific cardiovascular risk scale for patients with schizophrenia in Cuba; (2) It incorporates dimensions traditionally omitted in conventional scales, such as specific psychiatric variables and socio-environmental factors; (3) It uses a robust methodology for the development and validation of prognostic models; (4) It responds to the particularities of the Cuban health system and its socioeconomic context.
Future studies should evaluate the impact of the implementation of this scale on relevant clinical outcomes (cardiovascular mortality, non-fatal events, quality of life) and on the efficiency of health resource use. Likewise, it would be valuable to explore the possible utility of the scale in other severe mental disorders with high cardiovascular mortality, such as bipolar disorder.
Declarations
Authorship Contribution:
Berkis Martínez Hernández: Conceptualization, Investigation, Methodology, Writing - original draft, Project administration.
Lidiver Martínez Calderón: Formal analysis, Methodology, Validation, Visualization.
Betsy Lidivet Bonachea Sánchez: Supervision, Investigation, Writing - review & editing, Resources.
Ederlys Martín García: Investigation, Resources, Data curation, Writing - review & editing
Nailanys Puertos Matos: Investigation, Resources, Writing - review & editing
Juan Carlos Mirabal Requena: Formal analysis, Methodology, Writing - review & editing
Funding: This study has not received external funding. Resources come from the authors' affiliated institutions.
Conflict of Interests: The authors declare no conflicts of interest.
Ethical aspects: Approved by the Research Ethics Committee of the University of Medical Sciences of Sancti Spíritus (Minutes No. 15/2023). Informed consent will be obtained from all participants.
Data availability: The anonymized database will be available upon reasonable request.
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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.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.
Dear Ms. Mayra Duenas, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. “The International Journal of Clinical Case Reports and Reviews represented the “ideal house” to share with the research community a first experience with the use of the Simeox device for speech rehabilitation. High scientific reputation and attractive website communication were first determinants for the selection of this Journal, and the following submission process exceeded expectations: fast but highly professional peer review, great support by the editorial office, elegant graphic layout. Exactly what a dynamic research team - also composed by allied professionals - needs!" From, Chiara Beccaluva, PT - Italy.
Dear Maria Emerson, Editorial Coordinator, we have deeply appreciated the professionalism demonstrated by the International Journal of Clinical Case Reports and Reviews. The reviewers have extensive knowledge of our field and have been very efficient and fast in supporting the process. I am really looking forward to further collaboration. Thanks. Best regards, Dr. Claudio Ligresti
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation. “The peer review process was efficient and constructive, and the editorial office provided excellent communication and support throughout. The journal ensures scientific rigor and high editorial standards, while also offering a smooth and timely publication process. We sincerely appreciate the work of the editorial team in facilitating the dissemination of innovative approaches such as the Bonori Method.” Best regards, Dr. Matteo Bonori.
I recommend without hesitation submitting relevant papers on medical decision making to the International Journal of Clinical Case Reports and Reviews. I am very grateful to the editorial staff. Maria Emerson was a pleasure to communicate with. The time from submission to publication was an extremely short 3 weeks. The editorial staff submitted the paper to three reviewers. Two of the reviewers commented positively on the value of publishing the paper. The editorial staff quickly recognized the third reviewer’s comments as an unjust attempt to reject the paper. I revised the paper as recommended by the first two reviewers.
Dear Maria Emerson, Editorial Coordinator, Journal of Clinical Research and Reports. Thank you for publishing our case report: "Clinical Case of Effective Fetal Stem Cells Treatment in a Patient with Autism Spectrum Disorder" within the "Journal of Clinical Research and Reports" being submitted by the team of EmCell doctors from Kyiv, Ukraine. We much appreciate a professional and transparent peer-review process from Auctores. All research Doctors are so grateful to your Editorial Office and Auctores Publishing support! I amiably wish our article publication maintained a top quality of your International Scientific Journal. My best wishes for a prosperity of the Journal of Clinical Research and Reports. Hope our scientific relationship and cooperation will remain long lasting. Thank you very much indeed. Kind regards, Dr. Andriy Sinelnyk Cell Therapy Center EmCell
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. It was truly a rewarding experience to work with the journal “Clinical Cardiology and Cardiovascular Interventions”. The peer review process was insightful and encouraging, helping us refine our work to a higher standard. The editorial office offered exceptional support with prompt and thoughtful communication. I highly value the journal’s role in promoting scientific advancement and am honored to be part of it. Best regards, Meng-Jou Lee, MD, Department of Anesthesiology, National Taiwan University Hospital.
Dear Editorial Team, Journal-Clinical Cardiology and Cardiovascular Interventions, “Publishing my article with Clinical Cardiology and Cardiovascular Interventions has been a highly positive experience. The peer-review process was rigorous yet supportive, offering valuable feedback that strengthened my work. The editorial team demonstrated exceptional professionalism, prompt communication, and a genuine commitment to maintaining the highest scientific standards. I am very pleased with the publication quality and proud to be associated with such a reputable journal.” Warm regards, Dr. Mahmoud Kamal Moustafa Ahmed
Dear Maria Emerson, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews’, I appreciate the opportunity to publish my article with your journal. The editorial office provided clear communication during the submission and review process, and I found the overall experience professional and constructive. Best regards, Elena Salvatore.
Dear Mayra Duenas, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews Herewith I confirm an optimal peer review process and a great support of the editorial office of the present journal
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. I am really grateful for the peers review; their feedback gave me the opportunity to reflect on the message and impact of my work and to ameliorate the article. The editors did a great job in addition by encouraging me to continue with the process of publishing.
Dear Cecilia Lilly, Editorial Coordinator, Endocrinology and Disorders, Thank you so much for your quick response regarding reviewing and all process till publishing our manuscript entitled: Prevalence of Pre-Diabetes and its Associated Risk Factors Among Nile College Students, Sudan. Best regards, Dr Mamoun Magzoub.
International Journal of Clinical Case Reports and Reviews is a high quality journal that has a clear and concise submission process. The peer review process was comprehensive and constructive. Support from the editorial office was excellent, since the administrative staff were responsive. The journal provides a fast and timely publication timeline.
Dear Maria Emerson, Editorial Coordinator of International Journal of Clinical Case Reports and Reviews, What distinguishes International Journal of Clinical Case Report and Review is not only the scientific rigor of its publications, but the intellectual climate in which research is evaluated. The submission process is refreshingly free of unnecessary formal barriers and bureaucratic rituals that often complicate academic publishing without adding real value. The peer-review system is demanding yet constructive, guided by genuine scientific dialogue rather than hierarchical or authoritarian attitudes. Reviewers act as collaborators in improving the manuscript, not as gatekeepers imposing arbitrary standards. This journal offers a rare balance: high methodological standards combined with a respectful, transparent, and supportive editorial approach. In an era where publishing can feel more burdensome than research itself, this platform restores the original purpose of peer review — to refine ideas, not to obstruct them Prof. Perlat Kapisyzi, FCCP PULMONOLOGIST AND THORACIC IMAGING.
Dear Grace Pierce, International Journal of Clinical Case Reports and Reviews I appreciate the opportunity to review for Auctore Journal, as the overall editorial process was smooth, transparent and professionally managed. This journal maintains high scientific standards and ensures timely communications with authors, which is truly commendable. I would like to express my special thanks to editor Grace Pierce for his constant guidance, promt responses, and supportive coordination throughout the review process. I am also greatful to Eleanor Bailey from the finance department for her clear communication and efficient handling of all administrative matters. Overall, my experience with Auctore Journal has been highly positive and rewarding. Best regards, Sabita sinha
Dear Mayra Duenas, Editorial Coordinator of the journal IJCCR, I write here a little on my experience as an author submitting to the International Journal of Clinical Case Reports and Reviews (IJCCR). This was my first submission to IJCCR and my manuscript was inherently an outsider’s effort. It attempted to broadly identify and then make some sense of life’s under-appreciated mysteries. I initially had responded to a request for possible submissions. I then contacted IJCCR with a tentative topic for a manuscript. They quickly got back with an approval for the submission, but with a particular requirement that it be medically relevant. I then put together a manuscript and submitted it. After the usual back-and-forth over forms and formality, the manuscript was sent off for reviews. Within 2 weeks I got back 4 reviews which were both helpful and also surprising. Surprising in that the topic was somewhat foreign to medical literature. My subsequent updates in response to the reviewer comments went smoothly and in short order I had a series of proofs to evaluate. All in all, the whole publication process seemed outstanding. It was both helpful in terms of the paper’s content and also in terms of its efficient and friendly communications. Thank you all very much. Sincerely, Ted Christopher, Rochester, NY.
