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JSM Burns and Trauma

Prevalence, Severity and Factors Associated with Low Serum Vitamin D Levels Among Diabetic Foot Ulcer Patients: A Multicenter Investigation in Western Uganda

Review Article | Open Access | Volume 8 | Issue 1

  • 1. Department of Surgery, Kampala International University Western Campus, Uganda
  • 2. Department of Clinical Pathology, Kampala International University Western Campus, Uganda
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Corresponding Authors
Eunice Inomu, Department of Surgery, Kampala International University Western Campus, UgandaUmaru Kabuye, Department of Surgery, Kampala International University Western Campus, Uganda
Abstract

Background: Diabetic foot ulcers (DFUs), significantly burden health and socioeconomic systems, primarily due to peripheral neuropathy and uncontrolled glucose levels. Emerging research suggests a link to micronutrient deficiencies, notably vitamin D. Despite hypotheses that vitamin D deficiency impedes DFU healing and worsens outcomes, data on this association in our setting are limited. This study therefore aimed to determine the prevalence, severity, and factors associated with low serum vitamin D levels among DFU patients in Western Uganda.

Methods: In this cross-sectional study, we recruited participants diagnosed with DFUs who exhibited low serum vitamin D levels. The study utilized bedside vitamin D rapid diagnostic tests to assess these levels, alongside evaluating patient characteristics and applying the Wagner classification system to classify DFUs. Data analysis was conducted using Stata version 14.2, with statistical significance defined as p < 0.05.

Results: 109 patients with DFUs were assessed, with 83.5% showing low serum vitamin D levels. Among those with low serum vitamin D levels, Wagner grade 3 ulcers predominated (35.1%). The cohort was predominantly male (72.5%), with a mean age of 58 years; the majority had primary education or lacked formal schooling (74.7%). Additionally, 28.6% reported alcohol use, 24.2% reported smoking, and 68.8% had hypertension. In regression analysis, a history of smoking was associated with low serum vitamin D levels among DFU patients (AOR = 3.168, CI: 1.050-9.561, p = 0.041). A history of having a nephropathy was also associated with low vitamin D levels (AOR=3.630, CI: 1.315-10.02, p=0.01), additionally patients who rarely ate fruits and vegetables were also associated with having low serum vitamin D levels (AOR=3.426, CI: 1.105-10.84, p=0.036), and late Wagner grades of DFUs were associated with low serum vitamin D levels (AOR = 0.187, CI: 0.073-0.478, p < 0.001).

Conclusion: Patients with DFU, particularly those with advanced Wagner grades and who smoke, are at increased risk of vitamin D insufficiency or deficiency. Also, patients who have a nephropathy and those that rarely have fruits or vegetables in their diet have an increased risk of having vitamin D deficiency or insufficiency.

Recommendations: Based on our findings, we recommend regular monitoring of vitamin D levels in DFU patients, particularly smokers, patients with nephropathy and supplementation for those with suboptimal levels

KEYWORDS
  • Diabetic Foot Ulcer
  • Vitamin D
  • Western Uganda
CITATION

Inomu E, Kabuye U, Tajab EMA, Kiswezi A, Mugenyi M (2025) Prevalence, Severity and Factors Associated with Low Serum Vitamin D Levels Among Diabetic Foot Ulcer Patients: A Multicenter Investigation in Western Uganda. JSM Burns Trauma 8(1): 1051.

INTRODUCTION

Diabetic foot ulcers (DFUs), significantly burden health and socioeconomic systems, primarily due to peripheral neuropathy and uncontrolled glucose levels. Emerging research suggests a link to micronutrient deficiencies, notably vitamin D. Despite hypotheses that vitamin D deficiency impedes DFU healing and worsens outcomes, data on this association in our setting are limited. This study therefore aimed to determine the prevalence, severity, and factors associated with low serum vitamin D levels among DFU patients in Western Uganda.

METHODS

Study Design

This investigation implemented a cross-sectional study involving all patients diagnosed with diabetic foot ulcers with low serum vitamin D levels.

Study Site and Setting

This multicenter study was conducted at three hospitals in western Uganda under the Ministry of Health. The study sites included Fort Portal Regional Referral Hospital and Kitagata General Hospital, both government institutions, as well as the private Kampala International University Teaching Hospital. Each of these regional referral hospitals provides specialized diabetic care through dedicated diabetic clinics, surgical departments, and orthopaedic wards.

The diabetic clinics operate on specific days, catering to ambulatory diabetic patients, including those with diabetic foot ulcers. On average, these clinics attend to approximately 20 diabetic patients per week, with around 5 presenting with diabetic foot ulcers. Patients with severe diabetic foot ulcers are typically admitted for more intensive interventions, such as debridement or possible amputation, based on the clinical assessment by the attending healthcare professionals in the surgical wards. These hospitals possess the necessary facilities to conduct a range of laboratory investigations, including the measurement of vitamin D levels.

Target Population

All patients who presented with DFUs at the study centers during the study period

Study Population: All participants aged 18 years and older who presented with DFUs at the study sites during the specified study period.

Inclusion Criteria

All patients aged 18 years and above diagnosed with DFUs with low serum vitamin D levels, specifically defined as below 30 ng/ml.

Exclusion Criteria

Patients receiving oral vitamin D supplementation DFU patients below18 years.

Sample Size and Sample Size Determination

According to the participating hospitals registries, a total of 180 new cases DFU were diagnosed over 6 months. When the anticipated study period of 5months was incorporated, the finite population was 150 new DFU cases.

Using Cochrane’s formula for sample size calculation of finite populations, where N= desired sample size; Z= Standard normal deviate (1.96 for a 95% confidence interval); P= prevalence of low serum vitamin D levels in DFU patients; d= the acceptable error margin (0.05). Since prevalence of low serum vitamin D levels in DFU patients is unknown, P=0.5

N=Z*2P(1-P)/d*2

N=1.96*2 0.5(1-0.5)/0.05*2=385

N=385patients

For finite population correction: n=N/(1+(N-1)/N*) = 385/ (1+(385-1)/150) =109patients

STUDY VARIABLE

The following outcome variables were selected based the existing literature

Primary outcome variables: The primary outcome variable is the prevalence of low serum vitamin D levels.

Secondary outcome variables: The secondary outcome variable encompassed potential covariates hypothesized to correlate with diminished serum vitamin D levels. These covariates included age, gender, comorbidities, smoking status, BMI, and alcohol consumption.

Tertiary outcome variables: The tertiary outcome variables encompassed diabetic foot ulcer severity, measured using the Wagner classification.

Study Procedure

Eligible participants who provided informed consent underwent documentation of demographic and patient characteristics using a pretested and predetermined questionnaire. Subsequently, Wagner grading for diabetic foot ulcers was conducted, wherein Grade 0 signifies healthy skin, Grade 1 indicates the presence of a superficial ulcer, Grade 2 denotes a deep ulcer, Grade 3 signifies a deep ulcer with complications such as abscess or bone involvement, and Grade 4 indicates gangrene. Serum vitamin D levels of the patients were measured using a qualitative technique, and the results were recorded in the questionnaire.

Following the data collection process, patients continued with their routine care.

Data Collection

Data were collected by the principal investigator with the assistance of research assistants, who were doctors on duty in surgical wards and diabetic outpatient clinics. The data collection utilized an administered, pre-tested questionnaire originally designed in English. For participants who did not understand English, the questionnaire was interpreted and translated into local languages understood by the patients.

The data encompassed socio-demographic variables, patient characteristics, severity of the diabetic foot at recruitment, and determination of serum vitamin D levels at the study initiation. Patients were subsequently subjected to routine care.

Collected data were double-entered into Microsoft Excel 2019 and subsequently transferred to STATA version 15.0 for analysis.

Data Quality Control

Rigorous adherence to predefined inclusion and exclusion criteria was consistently upheld throughout the study. The questionnaires underwent meticulous review to ensure the thoroughness and accuracy of the gathered data. Research assistants received comprehensive training and ongoing supervision from the principal investigator and study supervisors to ensure proficient use of data collection instruments and adherence to study protocols.

No restrictions were imposed on concurrent medical care or interventions during the study, thereby permitting necessary medical attention and treatment as warranted.

Data Analysis

The data were initially coded and entered into Excel version 2016, followed by export to Stata 14.2 for subsequent analysis. The prevalence of low serum vitamin D levels among DFU patients was determined by calculating the percentage of individuals with serum vitamin D concentrations below 30 ng/mL relative to the total number of DFU patients included in our study. The severity categories, demographic and clinical characteristics of DFU patients were summarized using frequencies and percentages. Logistic regression was conducted to identify factors associated with low serum vitamin D levels among DFU patients. Variables with a p-value ≤ 0.2 in bivariate analysis were included in multivariate analysis to adjust for potential confounders. Results were reported as odds ratios with 95% confidence intervals. Statistical significance was determined using a p-value threshold of less than 0.05.

RESULTS

The study included 109 patients diagnosed with DFUs with 91 individuals exhibiting low serum vitamin D levels and 18 patients having levels within the normal range, recruited from surgical and outpatient diabetic clinic settings. Serum vitamin D evaluation revealed an average concentration of 20 ng/mL. Over the study period, a total of 109 DFU patients were assessed. Of these, 91 individuals exhibited vitamin D levels ≤ 30 ng/mL, while only 18 patients had levels above this threshold, resulting in a prevalence of 83.5% for vitamin D insufficiency and deficiency among the sampled DFU patient population (Table 1).

Table 1: Prevalence of Low Serum Vitamin D Levels (<30 ng/mL) Among DFU Patients

Serum Vitamin D levels

Frequency(=N/109)

Percentage (%)

≥ 30ng/ml

18

16.5

<30ng/ml

91

83.5

The majority of patients (n=48, 52.7%), exhibited serum vitamin D levels within the deficient range. The distribution of DFU severity was characterized by a predominance of Wagner grade 3 ulcers (n=32, 35.2%), while Wagner grade 5 represented the smallest proportion (n=3, 3.3%). Notably, patients with more advanced Wagner grades of DFUs showed lower serum vitamin D levels; all Wagner grade 5 patients (100.0%), presented with serum vitamin D concentrations ≤ 10 ng/mL (Figure 1 and Table 2).

Figure 1 Severity of Serum Vitamin D Deficiency Across Different Wagner Grades of DFUs

Figure 1: Severity of Serum Vitamin D Deficiency Across Different Wagner Grades of DFUs

Table 2: Socio-Demographics and Clinical Characteristics of DFU Patients with Low Serum Vitamin D Levels

Variable

Frequency(n), N=91

Percentage (%)

Age by category

<50

21

23.1

50-59

23

25.3

60-69

36

39.5

70 and above

11

12.1

Sex

Female

25

27.5

Male

66

72.5

Education level

Primary

34

37.4

Secondary

3

3.3

Tertiary

20

22.0

No-formal education

34

37.3

Marital status

Married

79

86.8

Single

12

13.2

HIV status

No

83

91.2

Yes

8

8.8

Hypertension

No

23

25.3

Yes

68

74.7

History of smoking

No

69

75.8

Yes

22

24.2

History of alcohol consumption

No

65

71.4

Yes

26

28.6

DFU Severity (Wegner classification)

Grade 1

22

24.2

Grade 2

21

23.1

Grade 3

32

35.1

Grade 4

13

14.3

Grade 5

3

3.3

Nephropathy

No

35

38.5

Yes

56

61.5

Diet (fruits and vegetables)

Daily

0

0

occasionally

13

14.3

Rarely

64

70.3

Usually,

14

15.4

Carbohydrate

Daily

80

87.9

Occasionally Rarely

2

0

2.2

0

usually,

9

9.9

Protein

Daily

55

60.4

occasionally

6

6.6

Rarely

1

1.1

Usually,

29

31.9

Steroid use

No

70

76.9

Yes

21

23.1

BMI

Underweight

4

4.4

normal

68

74.7

Overweight

19

20.9

Residence

Rural

81

89.0

Urban

10

11.0

DFU (months)

>1

11

12.1

1-6

59

64.8

>6

21

23.1

This study cohort exhibited a distinct demographic and clinical profile. Predominantly male, comprising 72.5% (n=66) of participants, the mean age was 58 years. The 60–69-year age group represented the most common category at 39.5% (n=36), while individuals aged ≥70 years constituted a relative minority at 12.1% (n=11). Regarding education level, the majority reported primary education or no formal schooling (n=68, 74.7%). In terms of lifestyle factors, approximately a quarter of the cohort disclosed histories of alcohol consumption (n=26, 28.6%) and smoking (n=22, 24.2%). Additionally, hypertension emerged as a highly prevalent comorbidity, affecting 68.8% (n=74) of participants (Table 2).

In the bivariate analysis, late Wagner grades of DFUs were associated with low serum vitamin D levels among DFU patients (COR = 0.199, CI: 0.082-0.485, p < 0.001) (Table 3).

Table 3: Bivariate and Multivariate Analysis of Factors Associated with Low Serum Vitamin D Levels among DFU Patients

Variable

Low serum vitamin D n (%), N=91

Bivariate analysis

Multivariate analysis

COR (95%CI)

P-value

AOR (95%CI)

P-value

Education level

Primary

34(37.4)

Ref

Secondary

3(3.3)

0.808(0.066-9.821)

0.867

0.455(0.042-9.185)

0.584

Tertiary

20(22.0)

1.615(0.530-4.934)

0.400

1.720(0.542-7.034)

0.407

No-formal education

34(37.3)

2.046(0.777-5.386)

0.147

2.432(0.877-8.059)

0.110

History of smoking

No

69(75.8)

Ref

Yes

22(24.2)

2.414(0.896-6.506)

0.082

3.168(1.050-9.561)

0.041

Nephropathy

No

35(38.5)

Ref

Yes

56(61.5)

2.909(1.196-7.073)

0.018

3.630(1.315-10.02)

0.013

Diet (fruits and vegetables)

Occasionally

13(14.3)

Ref

Rarely

64(70.3)

0.346(0.096-1.240)

0.103

3.462(1.105-10.84)

0.036

Usually

14(15.4)

0.333(0.068-1.624)

0.174

0.202(0.034-1.191)

0.077

DFU Severity (Wegner classification)

Early Grades (1&2)

43(47.3)

Ref

Late Grades (3,4&5)

48(52.7)

2.199(0.082-5.485)

<0.001

2.187(2.273-5.478)

<0.001

To account for potential confounders, all variables with p-values ≤ 0.2 were included in a multivariate analysis. A history of smoking was associated with low serum vitamin D levels among DFU patients (AOR = 3.168, CI: 1.050-9.561, p = 0.041). Additionally, late Wagner grades of DFUs were associated with low serum vitamin D levels (AOR = 0.187, CI: 0.073-0.478, p < 0.001) (Table 3).

DISCUSSION

Participant demographic and clinical characteristics

Our cross-sectional study involved 91 participants with diabetic foot ulcers (DFUs), conducted over a 5-month period across surgical wards and diabetic clinics in five hospitals in Western Uganda.

This study found an average patient age of 58 years, with the largest cohort (39.5%) aged 60–69. This aligns with research from Bulgaria, Iran, the USA, and Greece, where mean ages for DFU patients were 59.1, 59.0, 55.7, and 61.9 years, respectively [1-4].

Additionally, our study revealed a higher prevalence of DFUs among male patients compared to females. This male predominance was consistently observed across the various studies on DFUs that we reviewed [4-6].

The majority of patients were married (79%), and 28.6% reported a history of alcohol consumption. These findings are consistent with Sikhondze’s and Vahwere’s studies, which documented alcohol use in 30.6% and 22.2% of their DFU cohorts, respectively [7,8].

Our cohort had 8.8% of patients either known or newly diagnosed with HIV, which is lower than the 17.7% reported by Sikhondze [7]. This discrepancy may be attributed to variations between the study centers.

Regarding education level, most participants (n=68, 74.7%) had only primary education or no formal schooling. This is consistent with Malik et al.’s study, which reported 74.3% of patients with low or no formal education [9]. This likely reflects a limited understanding of diabetic foot care. Conversely, a Saudi Arabian study found that higher education levels—secondary and university—correlated with better knowledge of diabetic foot care, thereby reducing DFU risk [10].

Additionally, hypertension was a prevalent comorbidity, affecting 68.8% (n=74) of participants.

This high prevalence is consistent with Odusan’s study, which also reported significant hypertension rates among DFU patients [11]. However, it contrasts with the Ethiopian study, which found a 37.8% prevalence [12]. This discrepancy may stem from variations in study populations, healthcare access, diagnostic criteria, or underlying genetic and environmental factors.

In our study, 52.7% of patients had late Wagner grades of DFUs. This is consistent with findings from Mexico and Indonesia, where late Wagner grades were prevalent in 93% and 70% of cases, respectively [13,14]. These studies also identified Wagner grade 3 ulcers as the most prevalent, consistent with our results. However, this contrasts with Sikhondze et al.’s findings, where the majority of patients had grade 2 ulcers (25.8%) [7]. The discrepancy is likely due to the delayed presentation of DFU patients in our cohort, possibly attributed to the asymptomatic nature of early ulcers and the erroneous belief that the wounds would heal spontaneously.

Prevalence of low serum vitamin D levels among DFU patients

The study revealed that 83.5% of DFU patients had either vitamin D insufficiency or deficiency, which closely matches findings by Greenhagen [3], at 78% and [15], at 84.6%. However, this prevalence is lower than the 100% reported by Dai J [16], and Privanto MH [17]. These discrepancies may stem from differences in sample size, geographic location, patient demographics, and study methodologies.

The majority of patients (n=48, 52.7%), exhibited serum vitamin D levels within the deficient range. The distribution of DFU severity was characterized by a predominance of Wagner grade 3 ulcers (n=32, 35.2%), while Wagner grade 5 represented the smallest proportion (n=3, 3.3%). Notably, patients with more advanced Wagner grades of DFUs showed lower serum vitamin D levels; all Wagner grade 5 patients (100.0%), presented with serum vitamin D concentrations ≤ 10 ng/mL (Table 2).

This study cohort exhibited a distinct demographic and clinical profile. Predominantly male, comprising 72.5% (n=66) of participants, the mean age was 58 years. The 60–69-year age group represented the most common category at 39.5% (n=36), while individuals aged ≥70 years constituted a relative minority at 12.1% (n=11). Regarding education level, the majority reported primary education or no formal schooling (n=68, 74.7%). In terms of lifestyle factors, approximately a quarter of the cohort disclosed histories of alcohol consumption (n=26, 28.6%) and smoking (n=22, 24.2%).

Additionally, hypertension emerged as a highly prevalent comorbidity, affecting 68.8% (n=74), of participants, in terms of patients who had documented nephropathy were (n=56, 61.5%), majority of the patients had nephropathy with evidence.

When it comes to diet, majority of the patients rarely ate fruits and vegetables (n=64,70.3%), when it came to carbohydrates, and proteins (n=80,87.9%) and (n=55,60.4%) respectively, had these meals daily, a few of the patients used steroids (n=21,23.1%), and majority of the patients had normal body weight (n=68, 74.7), also majority of the patients were from rural areas (n=81,89%).

When it came to duration of having the diabetic foot ulcers in months, majority of the patients had had the ulcers between 1-6 months duration (n=59,64.8%) (Table 2).

In a study done by Tiwari, he found that Vitamin D deficiency was found in 71.4% of the diabetic foot infection cases,61.6% of the diabetic controls and 48.6% of the healthy volunteers ,however severe deficiency was most common in diabetic foot infections cases than in control and healthy volunteers (48.2,20.5 and 7.6%) respectively [18].

Severity of serum vitamin D deficiency among patients with different Wagner’s grades of DFUs in Western Uganda

The majority of patients (52.7%), had serum vitamin D levels in the deficient range. This contradicts Tsitsou’s findings, where 78.9% of patients with both DFUs and low serum vitamin D levels fell into the insufficient range [4].

Most patients with Wagner grades 1 and 2 had serum vitamin D levels in the insufficient range (>10 ng/ mL), whereas those with Wagner grades 3 and above predominantly had deficient serum vitamin D levels. This aligns with Darlington’s study findings [19].

Patients with late grades of DFU (grade 3,4 &5), were two times more likely to have low levels of Vitamin D levels as compared to those with early grades (1,2), according to the findings in our study.

Factors associated with low serum vitamin D levels among DFU patients

Late Wagner DFUs were associated with lower serum vitamin D levels among DFU patients. This finding is supported by both Dai’s systematic review and meta- analysis, and Tiwari’s study, which indicate a significant decrease in serum vitamin D levels as DFU severity increases [18,20].

Anderson et al., reported that over 50% of their DFU cohort were smokers, which contradicts our finding of a 24.2% smoking rate [21]. However, in our study, smoking was associated with lower serum vitamin D levels. This may be attributed to the disruption of vitamin D metabolism by smoking, thereby reducing its effectiveness in promoting ulcer healing [22].

In a study done by Mohammed Reza et al., a comparison study where he studied two groups of participants, those with diabetic foot ulcers and those without diabetic foot ulcers, he studied the effects of dietary and herbal supplements with anti-oxidant properties on the process of wound healing which showed a positive effect on the wound healing, he also found that vitamin D levels were significantly low in patients with DFU as compared to those without DFU.

These findings align with our study where we found that patients who rarely ate fruits or vegetables were three times more likely to have low vitamin D levels and hence were at a higher risk of developing DFU [23].

According to his study, he stated that wound healing is a complicated process containing four steps: haemostasis, inflammation, proliferation and tissue remodelling. One of the possible mechanisms through which nutrients affect DFU is reducing free radicals and oxidative parameters, and hence eating vegetables and fruits is protective.

In a comparison study done by Priyanto in India, he found that vitamin D decreases pro inflammatory cytokines and increases anti-inflammatory responses. He also noted that longer duration of DFU and vitamin D deficiency had a significantly negative effect on the rate of DFU healing, this aligns with our study which noted that duration of DFU was not significant and had no effect on levels of vitamin D in blood [17].

Patients with nephropathy were 3.6 times more likely to have low serum vitamin D levels as compared to their counterparts without nephropathy from our study, however this conflicts with a study done by Ying Xiao in China where he found that the correlation between vitamin D deficiency and nephropathy was not statistically significant, this could have been probably due to the differences in the study population and the covariates included in the regression analyses.

DECLARATIONS

Acknowledgements

We thank John Oryem for his help with data collection and consented for his name to be published

Authors” contributions

E.I. served as the Principal Investigator, leading the study’s design, literature review, data collection, analysis and manuscript review. U.K. wrote, analyzed data and critical reviewed the manuscript. M.M., E.M.A.T., and A.K. provided critical manuscript reviews. All authors read and approved the final manuscript

Human Ethics and Consent to Participate

This study was performed in accordance with the Declaration of Helsinki and all methods were performed in  accordance  with  the  relevant  guidelines  and regulations. Ethical approval was granted by the Bishop Stuart University Research and Ethics committee and all participants and or their legally authorized representatives signed an informed consent form prior recruitment into the study.

Availability of data and materials

All materials are accessible to any scientist seeking non-commercial utilization, without breaching the confidentiality of participants from the corresponding authors on reasonable request.

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Inomu E, Kabuye U, Tajab EMA, Kiswezi A, Mugenyi M (2025) Prevalence, Severity and Factors Associated with Low Serum Vitamin D Levels Among Diabetic Foot Ulcer Patients: A Multicenter Investigation in Western Uganda. JSM Burns Trauma 8(1): 1051.

Received : 12 Apr 2025
Accepted : 30 Apr 2025
Published : 30 Apr 2025
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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
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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