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Archives of Palliative Care

Electrocardiographic Changes in Canine Babesiosis

Research Article | Open Access Volume 2 | Issue 2 |

  • 1. Department of T.V.C.C, West Bengal University of Animal and Fishery Sciences, India
  • 2. Division of Veterinary Medicine, Indian Veterinary Research Institute, India
  • 3. College of Veterinary Science, Guwahati
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Corresponding Authors
Chaudhuri Shubhamitra, Department of T.V.C.C, West Bengal University of Animal and Fishery Sciences, Faculty of Veterinary and Animal Sciences, India Tel: 919874579755; Fax: 9125571986;
Abstract

Canine babesiosis, a tick- borne haemoprotozoan disease, characterized by both intravascular and extravascular haemolysis leading to regenerative anaemia, anaemic hypoxia, and metabolic acidosis. ECG changes have never been studied in canine babesiosis caused by B. gibsoni which is more pathogenic and prevalent in India. However, ECG changes occurred in up to 40% cases of canine babesiosis caused by B. canis rossi. The study was conducted to describe the ECG changes in naturally occurring cases of canine babesiosis caused by B. gibsoni. Study was performed on 189 clinical cases diagnosed with canine babesiosis, referred at Medical wing of the Referral Veterinary Polyclinic of the Institute during 2005-2006 by using a 12 lead BPL- ECG machine (CARDIART-408). The mean heart rate (151.3 ± 53.3) was found slightly higher than the standard reference value. Population mean of ‘P’ amplitude (0.17 ± 0.007) and ‘QRS’ duration (0.04 ± 0.02) were found to be slightly lower. Other parameters like ‘P’ duration (0.03 ± 0.01), ‘R’ amplitude (1.05 ± 0.51), ‘R-R’ interval (0.46 ± 0.15) ‘QT’ duration (0.15 ± 0.03), ‘PR’ duration (0.09 ± 0.06) and T: R ratio (0.26 ± 0.26) did not differ much from the standard reference values. The prevalence of electrographic abnormalities were prevalent in 51.3% cases of canine babesiosis with a highest prevalence of tachycardia followed by low voltage complex, sinus arrhythmia, tachy arrhythmia, and atrial fibrillation. The dogs with Babesia infection also showed various types of complex changes. From the present study it appears that the ECG changes in canine babesiosis are multifactorial and heart suffers from same pathological process.

Keywords

• B. gibsoni

• Canine

• Dog

• ECG

• Electrocardiograph

Citation

Chaudhuri S, Varshney JP, Changkija B (2017) Electrocardiographic Changes in Canine Babesiosis. Arch Palliat Care 2(2): 1014.

ABBREVIATIONS

ECG: Electrocardiogram; B. gibsoni: Babesia gibsoni; E. canis: Ehrlichia canis; E. platys: Ehrlichia platys

INTRODUCTION

Canine babesiosis, a tick- borne haemoprotozoan disease caused by the species of Babesia (B. canis, B. gibsoni and B. vogeli) is well documented in tropical and subtropical regions of the world. In India both B. canis [1,2] and B. gibsoni [3-6] infections have been reported. Importance of canine babesiosis varies in different regions of the world and in different states of the country, owing to strain or species variations of Babesia and various ecological factors [7]

Babesiosis is characterized by both intravascular and extravascular haemolysis leading to regenerative anaemia, anaemic hypoxia, and metabolic acidosis. Parasitaemia, destruction of organism (Babesia spp.) and erythrocytes may result in activation of various inflammatory mediators causing pyrexia [8,9]. Molecular mediators of multiple organ dysfunctions including cytokines, nitric oxide and free oxygen radicals are generated by the host tissues in response to parasite rather than directly from parasite itself [9]. Complicated babesiosis is associated with dysfunction of other organs. It is speculated that cardiac changes may develop in canine babesiosis owing to overwhelming inflammatory response and anaemic-hypoxic state [10]. Ischaemia and myocarditis can decrease resting potential of the involved cells leading to a conductional block resulting in arrhythmias [11]. Such changes are well documented in human cardiology and are accompanied by typical electrocardiographic changes. Cardiac changes have been described in human malaria. Its acute phase has many similarities to canine babesiosis [12]. Researchers conducted in Pretoria (South Africa) have indicated that ECG changes occurred in up to 40% cases of canine babesiosis caused by B. canis rossi. However, ECG changes have never been studied in canine babesiosis caused by B. gibsoni which is more pathogenic and prevalent in India, Malaysia, Korea, Egypt, Japan and United States.

The purpose of this study was to describe ECG changes in naturally occurring cases of canine babesiosis caused by B. gibsoni.

MATERIALS AND METHODS

Study design

A prospective study was performed on 189 dogs of different breeds (Pomeranian, German shepherd, Non-descript, Labrador, Dobermann, Great Dane, Sptiz, Boxer, Bhutia, Dalmatian, Cockerspaniel, Apso, Rampur hound, Rottweiler, Golden Retriever, Dachschund, Greyhound and Nepolian Mastiff) diagnosed with canine babesiosis. All the dogs were client- owned and were referred at Medical wing of the Referral Veterinary Polyclinic of the Institute.

Inclusion criteria

Ailing dogs found cytologically positive for small Babesia simulating to Babesia gibsoni on the examination of their capillary blood smears prepared freshly from ear tip and stained with Giemsa stain.

Cytologically B. gibsoni positive dogs having no cardiac disease previously diagnosed or treated or suspected at presentation.

Exclusion criteria

Dogs with B. gibsoni having concurrent infection of Ehrlichia canis, E. platys, Trypanosoma evansi or Dirofileria immitis.

Dogs having chronic heart problem.

Dogs having unusual clinical signs not previously observed in Babesia infection.

Each ailing dog was compiled on a 20 point scale having clinical sign as anorexia/partial appetite, dehydration, pyrexia, dullness/depression, diarrhoea/constipation, pale mucosa, ticks on body, hepatolmegaly, vomiting/nausea, splenomegaly, rapid thready pulse, nasal discharge, ataxia/CNS signs, distended abdomen/ascites, dysponea, yellow coloured urine, emaciation/ weight loss, epistaxis, occular discharge and edema. Presence of each clinical sign was assigned 01 mark.

ELECTROCARDIOGRAPHIC EXAMINATION

Electrocardiographic recoding was made by using a 12 lead BPL- ECG machine (CARDIART-408). The dogs were restrained in right lateral recumbancy on a table having foam cushion and rubber matting and were made comfortable before taking electrocardiogram. The legs were positioned parallel to each other and vertical to the long axis to the body and keeping the head and neck flat on the table. The skin and electrodes were moistened with the alcohol. The right forelimb (RA) and left forelimb (LA) electrode were placed proximal to the olecranon on the caudal aspect of the respective forelegs. The right hind limb (RF) and left hind limb (LF) electrodes were placed over the patellar ligament on the anterior aspect of the respective hind limbs. Sedation was not used in any dog. Sensitivity and paper speed were set at 1 and 25mm sec-1, respectively Manual Hum filter (notch filter at 50Hz) and EMG filter (cut off frequency of -3dB at 35 Hz) were used to minimize the disturbances. A one minute lead II ECG was recorded in all dogs. The following parameters were evaluated from ECG tracing on lead II:

Arrhythmias, classified according to their origin, named in standard way [13] and their prevalence.

Cardiac rhythm, classified as sinus arrhythmia, regular.

Presence of ST coving

Heart rate was calculated by counting the R-R intervals over 5 non-consecutive 3 seconds intervals multiplied by 4.

The following parameters were measured and averaged for 5 non-consecutive R-R intervals on lead II:

P- wave amplitude and duration

PR- interval duration

R- wave amplitude

QRS- duration

QT- interval duration

T- wave amplitude

ST- segment depression or elevation

DATA ANALYSIS

The numerical parameters were compared to the standard dog ECG [13] and noted as categorical variables. The following parameters were categorized as normal, high or low: heart rate, ‘P’ amplitude, ‘R’ amplitude, and ‘T’ amplitude; following parameters were categorized as normal, prolonged or shortened: ‘P’ duration, ‘QRS’ duration, ‘QT’ duration and ‘PR’ duration; and R-R interval was classified as regular or irregular. ‘T’ amplitude was evaluated as a T/R ratio. A ratio of 0.25 was regarded as normal and a ratio below 0.25 as low.

The data was analyzed according to [14]. Each ECG parameters was analyzed for percentage of abnormal and normal observations.

RESULTS

One hundred eighty nine dogs with babesiosis were included in this phase of the study. The main clinical signs were anorexia/partial appetite, dehydration, temperature, dull/ depressed, diarrhoea/constipation, pale mucosa, ticks on body, hepatolmegaly, vomiting/nausea, splenomegaly, rapid thready pulse, nasal discharge, ataxia/CNS signs, distended abdomen/ ascites, dysponea, yellow coloured urine, emaciation/weight loss, epistaxis, occular discharge and edema in various combinations. An overall mean clinical score, based on 20 point scale, was 8.47 ± 0.27 with an individual score varying from 3 to 14. These dogs were cytologically positive for B. gibsoni having parasitaemia ranging from 1.30% to 15.50%

Measurable data derived from the lead II of the ECG strips of a population of 189 dogs, diagnosed with babesiosis caused by B. gibsoni, are summarized in (Table 1).

Tables

Table 1: Electrocardiographic measurements of 189 dogs with babesiosis (Mean ± SD).

Parameters

Standard Reference value

Mean value (±SD)

Heart rate

70-160 (adults)

151.34±53.36

(beat/min)

60-140 (Large)

(50-360)

 

<180 (toy)

 
 

<220 (puppies)

 

P amplitude (mv)

<0.4

0.17±0.07

   

(0-0.4)

P duration (Sec)

<0.05 (Large)

0.03±0.01

 

<0.04 (Small)

(0.02-0.08)

R amplitude (mv)

0.5-3 (large)

1.05±0.51

 

0.5-2.5 (small)

(0.21-2.7)

R-R interval (sec)

-

0.46±0.15

   

(0.208-0.912)

QRS duration (Sec)

0.06 (large)

0.04±0.02

 

0.05 (small)

(0.02-0.06)

QT duration (Sec)

0.15-0.25

0.15±0.03

   

(0.08-0.28)

PR duration (Sec)

0.06-0.13

0.09±0.06

   

(0.04-0.16)

T:R ratio

<0.25

0.26±0.25

   

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The mean heart rate (151.34 ± 53.36) was slightly higher than the standard reference value. Population mean of ‘P’ amplitude (0.17 ± 0.007) and ‘QRS’ duration (0.04 ± 0.02) were found to be slightly lower. Other parameters like ‘P’ duration (0.03 ± 0.01), ‘R’ amplitude (1.05 ± 0.51), ‘R-R’ interval (0.46 ± 0.15) ‘QT’ duration (0.15 ± 0.03), ‘PR’ duration (0.09 ± 0.06) and T: R ratio (0.26 ± 0.26) did not differ much from the standard reference values.Nevertheless, heart rate was high in 51 and low in 4; ‘P’ amplitude was low in 3; ‘R’ amplitude was low in 17; ‘R-R’ interval was irregular in 15; ‘QRS’ duration was prolonged in 6 and shortened in 9; ‘QT’ duration was prolonged in 1 and shortened in 5; ‘PR’ duration was prolonged in 3 and shortened in 7; and ‘T’ amplitude was low in 39 dog (Table 2).

Table 2: Prevalence of abnormalities in electrocardiogram among measurable parameters in dogs with babesiosis.

Parameters

No. of case

Standard Reference value

Heart rate (beats/min)

High

51

70-160 (adults)

Normal

134

60-140 (giant)

Low

4

<180 (toy)

   

<200 (puppies)

P amplitude (mV)

High

0

<0.4

Normal

186

 

Low

3

 

P duration (sec)

Prolonged

0

<0.04

Normal

189

<0.05 (giant)

R amplitude (mV)

High

0

0.5-3 (large)

Normal

172

172

Low

17

0.5-2.5 (small)

R-R interval (sec)

Regular

174

 

Irregular

15

 

QRS duration (sec)

Prolonged

6

0.06 (large)

Normal

174

 

Shortened

9

0.05 (small)

QT duration (sec)

Prolonged

1

0.15-0.25

Normal

130

 

Shortened

58

 

PR duration (sec)

Prolonged

3

0.06-0.13

Normal

179

 

Shortened

7

 

 T amplitude (mV)

High

0

 

Normal

150

 

Low

39

 

The prevalence of electrographic abnormalities was studied in 189 dogs having babesiosis due to natural infection of B. gibsoni. The results of abnormalities detected in the ECG strips are given in (Table 3).

Table 3: Prevalence of electrocardiographic changes in dogs with babesiosis.

ECG Changes

No. of case

Percentage

A. Single Changes

89

47.10

Sinus arrhythmia

12

13.48

Tachycardia

32

35.96

Tachyarrhythmia

06

6.74

Bradycardia

02

2.25

Bradyarrhythmia

01

1.12

Atrial fibrillation

05

5.62

Atrial paroxysmal tachycardia

01

1.12

Sinus arrest

04

4.49

Mobitz type II heart block

03

3.37

Low voltage comples (LVC)

16

17.98

Ventricular premature complex (VPC)

02

2.25

ST depression

03

3.37

ST elevation

01

1.12

ST coving

01

1.12

B. Multiple changes

08

4.23

ST coving and broad QRS

02

25.0

ST elevation with coving

01

12.5

ST depression and atrial fibrillation

01

12.5

ST depression and tachycardia

01

12.5

ST depression and sinus arrest

01

12.5

ST depression, broad QRS, ST coving and

 

 

increased R wave amplitude

01

12.5

Low voltage complex (LVC) and tachycardia     01                                   12.5

 

 

C. Normal (No change/Sinus rhythm)

92

48.68

Total

 

189

51.32% dogs with babesiosis, due to B. gibsoni, were found to have either single (47.10%) or multiple (4.23%) abnormalities in the ECG strips. Of the 89 dogs having single ECG abnormality, the prevalence of tachycardi(Figure 1 ),

 Figure 1 Showing Sinus Tachycardia.

Figure 1 Showing Sinus Tachycardia.

low voltage complex (Figure 2)

 Figure 2 Showing Low Voltage Complex (LVC)

Figure 2 Showing Low Voltage Complex (LVC)

, sinus arrhythmia (Figure 3),

 Figure 3 Showing Sinus Arrhythmia

Figure 3 Showing Sinus Arrhythmia

tachy arrhythmia (Figure 4),

 Figure 4 Showing Tachyarrhythmia.

Figure 4 Showing Tachyarrhythmia.

atrial fibrillation (Figure5) 

Figure 5 Showing Atrial Fibrillation

Figure 5 Showing Atrial Fibrillation

sinus arrest(Figure 6),

 Figure 6 Showing Sinus Arrest

Figure 6 Showing Sinus Arrest

Mobitz type II heart block; ST depression (> 0.2 mV), ventricular premature complex (VPC) (Figure 7),

 Figure 7 Showing Ventricular Premature Complex (VPC).

Figure 7 Showing Ventricular Premature Complex (VPC)

bradycardia (Figure 8),

 Figure 8 Showing Bradycardia

Figure 8 Showing Bradycardia

brady arrhythmia, ST elevation (> 0.15 mV) (Figure 9)

 Figure 9 Showing ST elevation.

Figure 9 Showing ST elevation.

and ST coving (Figure 10),

 Figure 10 Showing ST coving.

Figure 10 Showing ST coving.

atrial paroxysmal tachycardia (Figure 11)

 Figure 11 Showing Atrial Paroxysmal Tachycardia.

Figure 11 Showing Atrial Paroxysmal Tachycardia.

was to the tune of 35.96%, 17.98%, 13.48%, 6.74%, 5.62%, 4.49%, 3.37%, 3.37%, 2.25%, 2.25%, 1.12%, 1.12%, 1.12% and 1.12%, respectively

The dogs with Babesia infection also showed various types of complex changes viz, ST coving with broad QRS; ST elevation with coving; ST depression with atrial fibrillation; ST depression with tachycardia; ST depression with sinus arrest; ST depression, broad QRS, ST coaving with increased R wave amplitude, and low voltage complex with tachycardia accounting for 25.0%, 12.5%, 12.5%, 12.5%, 12.5%, 12.5% and 12.5% among the dogs with complex ECG changes (Table 3).

DISCUSSION

Electrocardiographic recordings of 189 dogs with babesiosis, caused by B. gibsoni, were studied. The study showed that ECG changes occurred in up to 51.32% dogs in some parameters. The prevalence of ECG abnormalities in dogs with babesiosis, caused by B. gibsoni, are on little higher side as compared to 40% reported in canine babesiosis in Africa, caused by B. canis [15]. The more common ECG changes were tachycardia, low voltage ‘R’ complex, sinus arrhythmia, tachyarrhythmia, atrial fibrillation and sinus arrest. The mean heart rate for the whole population was 151.34 ± 53.36 bpm which is slightly on the higher side of the normal range (Table 1) as reported in septic conditions [16]. Thirty two dogs had tachycardia and six dogs showed Tachyarrhythmia. Increased heart rate results in increased cardiac output to compensate for the anaemia and metabolic effects of the disease [18]. Population mean for ‘P’ amplitude (0.17 ± 0.07 mV), ‘P’ duration (0.03 ± 0.01 sec), ‘R’ amplitude (1.05 ± 0.51 mV), ‘QRS’ duration (0.04 ± 0.02 sec), ‘QT’ duration (0.15 ± 0.03 sec), ‘PR’ duration (0.09 ± 0.06 sec) was slightly on lower side and for T:R ratio (0.26 ± 0.25) was slightly on higher side than the mean standard reference values (Table 1) but these values did not differ significantly. Bradycardia was seen in two dogs with complicated disease and seems to be a poor prognostic indicator in canine babesiosis [15].

Sinus bradycardia associated with syncope and sudden death has been reported in cardiomyopathies [19]. Bradyarrhythmia observed in one dog had negative clinical impact on exercise due to cerebral hypoxia [20]. There was higher prevalence of cardiac arrhythmia which seems to be due to haemodynamic changes in babesiosis. Five of the dogs had atrial fibrillation, atrial paroxysmal tachycardia was seen in 01, sinus arrest in 04, second degree heart block in 03 and ventricular premature complexes in 02 dogs. Based on ECG findings of conduction abnormalities associated with irregular rhythm, the conduction system could have been involved in this inflammatory process. Sinus arrest is a failure to form an impulse. Sino-atrial block can be a normal incidental finding in the dog [21]. However, this is probably not the case in the present study as the dogs were sick and stressed. SA block can also be a result of extra cardiac causes viz., vagal irritation or hyperkalaemia [22]. Ventricular premature complex is a very non-specific arrhythmia that has been described in myocarditis owing to various causes [23], myocardial infarcts and ischaemia [24], septic condition [25], anaemia [22], and acid base electrolyte disturbances [26]. All these conditions are well documented in canine babesiosis, caused by B. gibsoni.

Three dogs in this study had Mobitz type II heart block. These can be incidental findings in the normal dogs [27], but in the present case, the dogs were sick and stressed. In sick dogs Mobitz type II A V block was seen after inducing ischaemic damage at the area of proximal bundle of His and increased heart rate [28]. This could occur in canine babesiosis. Such changes have also been reported in acute and chronic Chagas disease [17,29] and in other forms of myocarditis [23 ].

Low voltage ‘R’ complex was found in sixteen dogs. It is a common sign in pericardial effusion [30] and pleural effusion [22]. [15] observed a statistically significant correlation between the presence of small ‘R’ and pericardial effusion in cases of canine babesiosis caused by B. canis. Based on this study it appears that the prevalence of pericardial effusion in babesiosis, caused by B. gibsoni, was also higher. Effusion into cavities have been described as rare in canine babesiosis [31-33] but based on the present study the prevalence seems high. Low ‘R’ wave amplitude has been reported in association with myocardial disease, reduced left ventricular function [34-36] and myocardial infarction [37].

ST deviation (depression and elevation) and ST coving are non specific signs of myocardial ischaemia in dogs [22]. Diagnosis of myocardial ischaemia, based on ST deviation in different leads, is routine in human cardiology [38]. ST depression has been reported in humans with malaria [39], in dogs with ‘Chagas’ disease [29] myocardial infraction [40] and atherosclerosis [41]. In the present study, it was another sign supporting ischaemic changes within myocardium in canine babesiosis.

In 8 dogs with babesiosis more than one change in ECG strips were recorded (Table 3). ‘ST’ coving and broad ‘QRS’ seen in 2 dogs, were suggestive of left ventricular enlargement [22]. ‘ST’ elevation with coving indicated myocardial hypoxia or ischaemia. ‘ST’ depression with atrial fibrillation, ‘ST’ depression with tachycardia, ‘ST’ depression with sinus arrest, low voltage complex with tachycardia, and ‘ST’ depression with broad ‘QRS’, ‘ST’ coving and increased ‘R’ amplitude were also suggestive of myocardial ischaemia and/or myocardial involvement [22] in cases of canine babesiosis caused by B. gibsoni.

From the study it appears that the ECG changes in canine babesiosis are multifactorial and heart suffers from same pathological process, which has been observed for other organ involvement in canine babesiosis namely inflammatory reaction and ischaemia [9].

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Received : 28 Sep 2017
Accepted : 30 Nov 2017
Published : 01 Dec 2017
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Launched : 2014
JSM Arthritis
ISSN : 2475-9155
Launched : 2016
JSM Head and Neck Cancer-Cases and Reviews
ISSN : 2573-1610
Launched : 2016
JSM General Surgery Cases and Images
ISSN : 2573-1564
Launched : 2016
JSM Anatomy and Physiology
ISSN : 2573-1262
Launched : 2016
JSM Dental Surgery
ISSN : 2573-1548
Launched : 2016
Annals of Emergency Surgery
ISSN : 2573-1017
Launched : 2016
Annals of Mens Health and Wellness
ISSN : 2641-7707
Launched : 2017
Journal of Preventive Medicine and Health Care
ISSN : 2576-0084
Launched : 2018
Journal of Chronic Diseases and Management
ISSN : 2573-1300
Launched : 2016
Annals of Vaccines and Immunization
ISSN : 2378-9379
Launched : 2014
JSM Heart Surgery Cases and Images
ISSN : 2578-3157
Launched : 2016
Annals of Reproductive Medicine and Treatment
ISSN : 2573-1092
Launched : 2016
JSM Brain Science
ISSN : 2573-1289
Launched : 2016
JSM Biomarkers
ISSN : 2578-3815
Launched : 2014
JSM Biology
ISSN : 2475-9392
Launched : 2016
Archives of Stem Cell and Research
ISSN : 2578-3580
Launched : 2014
Annals of Clinical and Medical Microbiology
ISSN : 2578-3629
Launched : 2014
JSM Pediatric Surgery
ISSN : 2578-3149
Launched : 2017
Journal of Memory Disorder and Rehabilitation
ISSN : 2578-319X
Launched : 2016
JSM Tropical Medicine and Research
ISSN : 2578-3165
Launched : 2016
JSM Head and Face Medicine
ISSN : 2578-3793
Launched : 2016
JSM Cardiothoracic Surgery
ISSN : 2573-1297
Launched : 2016
JSM Bone and Joint Diseases
ISSN : 2578-3351
Launched : 2017
JSM Bioavailability and Bioequivalence
ISSN : 2641-7812
Launched : 2017
JSM Atherosclerosis
ISSN : 2573-1270
Launched : 2016
Journal of Genitourinary Disorders
ISSN : 2641-7790
Launched : 2017
Journal of Fractures and Sprains
ISSN : 2578-3831
Launched : 2016
Journal of Autism and Epilepsy
ISSN : 2641-7774
Launched : 2016
Annals of Marine Biology and Research
ISSN : 2573-105X
Launched : 2014
JSM Health Education & Primary Health Care
ISSN : 2578-3777
Launched : 2016
JSM Communication Disorders
ISSN : 2578-3807
Launched : 2016
Annals of Musculoskeletal Disorders
ISSN : 2578-3599
Launched : 2016
Annals of Virology and Research
ISSN : 2573-1122
Launched : 2014
JSM Renal Medicine
ISSN : 2573-1637
Launched : 2016
Journal of Muscle Health
ISSN : 2578-3823
Launched : 2016
JSM Genetics and Genomics
ISSN : 2334-1823
Launched : 2013
JSM Anxiety and Depression
ISSN : 2475-9139
Launched : 2016
Clinical Journal of Heart Diseases
ISSN : 2641-7766
Launched : 2016
Annals of Medicinal Chemistry and Research
ISSN : 2378-9336
Launched : 2014
JSM Pain and Management
ISSN : 2578-3378
Launched : 2016
JSM Women's Health
ISSN : 2578-3696
Launched : 2016
Clinical Research in HIV or AIDS
ISSN : 2374-0094
Launched : 2013
Journal of Endocrinology, Diabetes and Obesity
ISSN : 2333-6692
Launched : 2013
Journal of Substance Abuse and Alcoholism
ISSN : 2373-9363
Launched : 2013
JSM Neurosurgery and Spine
ISSN : 2373-9479
Launched : 2013
Journal of Liver and Clinical Research
ISSN : 2379-0830
Launched : 2014
Journal of Drug Design and Research
ISSN : 2379-089X
Launched : 2014
JSM Clinical Oncology and Research
ISSN : 2373-938X
Launched : 2013
JSM Bioinformatics, Genomics and Proteomics
ISSN : 2576-1102
Launched : 2014
JSM Chemistry
ISSN : 2334-1831
Launched : 2013
Journal of Trauma and Care
ISSN : 2573-1246
Launched : 2014
JSM Surgical Oncology and Research
ISSN : 2578-3688
Launched : 2016
Annals of Food Processing and Preservation
ISSN : 2573-1033
Launched : 2016
Journal of Radiology and Radiation Therapy
ISSN : 2333-7095
Launched : 2013
JSM Physical Medicine and Rehabilitation
ISSN : 2578-3572
Launched : 2016
Annals of Clinical Pathology
ISSN : 2373-9282
Launched : 2013
Annals of Cardiovascular Diseases
ISSN : 2641-7731
Launched : 2016
Journal of Behavior
ISSN : 2576-0076
Launched : 2016
Annals of Clinical and Experimental Metabolism
ISSN : 2572-2492
Launched : 2016
Clinical Research in Infectious Diseases
ISSN : 2379-0636
Launched : 2013
JSM Microbiology
ISSN : 2333-6455
Launched : 2013
Journal of Urology and Research
ISSN : 2379-951X
Launched : 2014
Journal of Family Medicine and Community Health
ISSN : 2379-0547
Launched : 2013
Annals of Pregnancy and Care
ISSN : 2578-336X
Launched : 2017
JSM Cell and Developmental Biology
ISSN : 2379-061X
Launched : 2013
Annals of Aquaculture and Research
ISSN : 2379-0881
Launched : 2014
Clinical Research in Pulmonology
ISSN : 2333-6625
Launched : 2013
Journal of Immunology and Clinical Research
ISSN : 2333-6714
Launched : 2013
Annals of Forensic Research and Analysis
ISSN : 2378-9476
Launched : 2014
JSM Biochemistry and Molecular Biology
ISSN : 2333-7109
Launched : 2013
Annals of Breast Cancer Research
ISSN : 2641-7685
Launched : 2016
Annals of Gerontology and Geriatric Research
ISSN : 2378-9409
Launched : 2014
Journal of Sleep Medicine and Disorders
ISSN : 2379-0822
Launched : 2014
JSM Burns and Trauma
ISSN : 2475-9406
Launched : 2016
Chemical Engineering and Process Techniques
ISSN : 2333-6633
Launched : 2013
Annals of Clinical Cytology and Pathology
ISSN : 2475-9430
Launched : 2014
JSM Allergy and Asthma
ISSN : 2573-1254
Launched : 2016
Journal of Neurological Disorders and Stroke
ISSN : 2334-2307
Launched : 2013
Annals of Sports Medicine and Research
ISSN : 2379-0571
Launched : 2014
JSM Sexual Medicine
ISSN : 2578-3718
Launched : 2016
Annals of Vascular Medicine and Research
ISSN : 2378-9344
Launched : 2014
JSM Biotechnology and Biomedical Engineering
ISSN : 2333-7117
Launched : 2013
Journal of Hematology and Transfusion
ISSN : 2333-6684
Launched : 2013
JSM Environmental Science and Ecology
ISSN : 2333-7141
Launched : 2013
Journal of Cardiology and Clinical Research
ISSN : 2333-6676
Launched : 2013
JSM Nanotechnology and Nanomedicine
ISSN : 2334-1815
Launched : 2013
Journal of Ear, Nose and Throat Disorders
ISSN : 2475-9473
Launched : 2016
JSM Ophthalmology
ISSN : 2333-6447
Launched : 2013
Journal of Pharmacology and Clinical Toxicology
ISSN : 2333-7079
Launched : 2013
Annals of Psychiatry and Mental Health
ISSN : 2374-0124
Launched : 2013
Medical Journal of Obstetrics and Gynecology
ISSN : 2333-6439
Launched : 2013
Annals of Pediatrics and Child Health
ISSN : 2373-9312
Launched : 2013
JSM Clinical Pharmaceutics
ISSN : 2379-9498
Launched : 2014
JSM Foot and Ankle
ISSN : 2475-9112
Launched : 2016
JSM Alzheimer's Disease and Related Dementia
ISSN : 2378-9565
Launched : 2014
Journal of Addiction Medicine and Therapy
ISSN : 2333-665X
Launched : 2013
Journal of Veterinary Medicine and Research
ISSN : 2378-931X
Launched : 2013
Annals of Public Health and Research
ISSN : 2378-9328
Launched : 2014
Annals of Orthopedics and Rheumatology
ISSN : 2373-9290
Launched : 2013
Journal of Clinical Nephrology and Research
ISSN : 2379-0652
Launched : 2014
Annals of Community Medicine and Practice
ISSN : 2475-9465
Launched : 2014
Annals of Biometrics and Biostatistics
ISSN : 2374-0116
Launched : 2013
JSM Clinical Case Reports
ISSN : 2373-9819
Launched : 2013
Journal of Cancer Biology and Research
ISSN : 2373-9436
Launched : 2013
Journal of Surgery and Transplantation Science
ISSN : 2379-0911
Launched : 2013
Journal of Dermatology and Clinical Research
ISSN : 2373-9371
Launched : 2013
JSM Gastroenterology and Hepatology
ISSN : 2373-9487
Launched : 2013
Annals of Nursing and Practice
ISSN : 2379-9501
Launched : 2014
JSM Dentistry
ISSN : 2333-7133
Launched : 2013
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