AUCTORES
Globalize your Research
Review Article | DOI: https://doi.org/10.31579/2690-8794/026
*Corresponding Author: Leonard Ranasinghe MD, Professor of Medical Education and Emergency Medicine, College of Medicine, California Northstate University, Elk Grove, CA, USA
Citation: Steven Wright, (2020) Samantha Peralta and Leonard Ranasinghe MD J, Clinical Medical Reviews and Reports .2(5);DOI: 10.31579/2690-8794/026
Copyright: © 2020, Leonard Ranasinghe MD:. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 07 July 2020 | Accepted: 08 July 2020 | Published: 12 August 2020
Keywords: targeted temperature management, adverse effects, seizures, myoclonus, sepsis, pneumonia, malignant arrhythmias, hypokalemia
Targeted Temperature Management has been the standard of care in post cardiac arrest since 2005. Despite significant advancements since its infancy, and a multitude of studies, discrepancies still exist as to its efficacy. By understanding the associated adverse effects, we can begin to delineate incongruencies to guide future research in order to progress towards a more uniform “high-quality” Targeted Temperature Management. Both anticonvulsant and antiarrhythmic therapy may provide an avenue towards improving Targeted Temperature Management.
Therapeutic hypothermia (TH) has been the standard of care in post-cardiac arrest since 2005 following the recommendation of the International Liaison Committee on Resuscitation. The ILCOR’s 2005 report recommended hypothermia induction for a duration of 12-24 hours in patients with return of spontaneous circulation (ROSC) after ventricular fibrillation [1].This recommendation followed data supported by two randomized controlled trials that demonstrated improvement in survival and neurologic outcome in patients who remained comatose following cardiac arrest when therapeutic hypothermia was performed[2, 3]. Current guidelines by the American Heart Association continue to recommend the use of TH (now referred to as targeted temperature management (TTM)) [4]. Substantial progress has been made when looking at the multitude of scientific literature available. In its infancy, TTM protocol was severely lacking, providing a recommendation without a methodology as to how to best provide TTM. This data was largely unavailable at the time. Current recommendations now provide tighter regulations in regard to duration of TTM and when to initiate TTM following cardiac arrest as well as a recommendation against rapid infusion of cold IV fluids [4]. Although significant advancement has been made in TTM protocol, there remains a lack of consensus as to how to maximize its beneficial effects.
Throughout its existence contradictory results about the benefits of TTM have been published. In 2018, Kalra, R., et al. argued that TTM may not actually improve neurologic outcome; considering the adverse effects of hypothermia on the body, it was argued that the risk may not outweigh the proposed benefits [5]. The large Hyperion study, however, confirmed the neurologic benefit of TTM following cardiac arrest [6]. Not only is there discrepancy in the efficacy of TTM, the assessed primary outcome (neurologic outcome vs survival) varies within the literature. Heterogeneity in regard to assessment of primary outcomes, TTM duration, how TTM is administered, pharmacologic management during TTM, targeted temperatures and monitoring of TTM may all be confounders amongst the data producing contradictory results. With clear discrepancies, questions remain regarding the efficacy of TTM. Following the Hyperion trail, the literature began to advocate for the necessity of controlled, “high-quality” TTM in order to begin answering these questions. High quality TTM involves early initiation, pharmacologic management of shivering and facilitation of cooling, a specific target temperature in the cooling phase with a prolonged rewarming phase and avoidance of fever after TTM [7]. With increased homogeneity, it is argued that high quality TTM can maximize the proposed benefits by minimizing associated adverse outcomes. Perhaps the biggest debate amongst the available literature is whether or not TTM administration provides enough of a benefit to outweigh its many documented adverse effects (AE). AE of TTM have been documented within almost every organ system and will be discussed in this review. Advanced understanding of these AE is essential for maximizing the benefits of TTM and minimizing AE.
Seizure and myoclonus in the advanced critical care period (defined as days 1–7 after ROSC) are well known AE of TTM documented extensively in the literature [8-12]. Through both univariate and multivariate analysis, seizure and myoclonus have been strongly correlated with poor neurologic outcome. Anticonvulsant therapy has shown mixed effects on neurologic outcome with both improvement and detriment at hospital discharge [8]. However, anticonvulsant use could not be considered an independent variable in the analysis and provides opportunity for further investigation. The strongest predictors of poor neurologic outcome have been shown to be incomplete brainstem reflexes (including pupillary, oculocephalic, corneal), myoclonus, elevated neuron specific enolase concentration and nonreactive hypothermic EEG [13]. Not surprisingly, evidence of neurologic injury strongly correlates with a poor neurologic outcome. Further investigation is needed in understanding how to improve TTM administration in a way that greatly reduces the risk of neurologic injury. The 2015 report by the AHA addressed this need by identifying gaps in current knowledge and suggesting areas for further research. Amongst the most pertinent to this discussion is identifying if “the use of targeted temperature management, including various temperature targets, affects long-term neurocognitive and functional outcomes” [4].
Possibly one of the greatest adverse effects seen post cardiac arrest and through TTM administration is the damaging immunologic response. Widespread activation of the immunologic cascade increases the risk of infection following reperfusion after cardiac arrest [14]. Though TTM is standard of care, it has also been shown to increase the risk of infection [15]. Pneumonia and sepsis are prominent infectious etiologies associated with TTM. However, when assessing a primary outcome of neurologic outcome at hospital discharge, only sepsis demonstrated a strong association with poor neurologic outcome through a multivariate analysis [8]. Though pneumonia was not associated with a poor neurologic outcome, minimizing it post TTM is important for improvement in general patient outcome. Prophylactic antibiotic treatment to minimize pneumonia risk has been a suggested mechanism towards improving patient functional outcome. Currently, the literature fails to support a significant association between antibiotic therapy and improvement in patient mortality or neurologic outcome [8, 16]. Although prophylactic antibiotic therapy may lower the incidence of pneumonia [8], further investigation is recommended before making conclusions about their effect on functional outcome.
Hemorrhage and thrombotic changes are established complications of non-medically induced hypothermia [17]. Thromboelastographic analysis of hypothermic patients has shown changes in multiple steps of the coagulation cascade, as well as delayed clot lysis [17]. Not surprisingly, similar complications have been reported in association with TTM, which is thought to be a result of a multitude of factors including elevated catecholamines, acidosis, tissue damage, and hypothermia-associated coagulopathy [17, 18]. A study of 975 patients revealed increased risk of bleeding complications when patients underwent PCI angiography before TTM [18], while a sub-study of the TTM trial evaluated the effect of temperature on bleeding and coagulation showed no difference in risk between 33°C and 36°C [17]. Despite this evidence, only 4-5% of patients undergoing TTM were shown to have this complication [8, 18]. Given the established neurologic benefit, the risk of these events is acceptable. Further work to delineate patient subsets who are at increased risk of serious hemorrhagic or thrombotic complications may help guide future clinical use of TTM.
EKG changes are also frequently observed in patients undergoing TTM. The presence of bradycardia during TTM is a potential predictor of positive outcome and was associated with an 18% improvement in mortality and a lower odds ratio of poor neurologic outcomes in a randomized trial [19]. Ventricular ectopic beats (VEB) were observed in the majority of patients undergoing TTM regardless of target temperature in another randomized trial [20]. The prevalence of VEB decreased as TTM progressed, and patients treated at 36°C had less VEB at the later time points, which continued to be significant after adjusting for possible confounders [20]. Despite this, the rate of ventricular tachycardia or fibrillation did not differ between groups, and the mortality and neurological outcome did not differ [20]. Similarly, the presence of Osborn waves increased with lower target temperature without increased ventricular arrhythmias [21]. Multiple studies have shown prolonged QT and corrected QT (QTc) while undergoing TTM, particularly in females and patients with anoxic brain injuries[22, 23]. No difference was observed in the QT interval between patients experiencing malignant arrhythmia (MA) and those who did not, regardless of the use of known QT prolongating drugs and other variables such as electrolyte imbalances [22].
MA (defined as ventricular fibrillation, sustained ventricular tachycardia, torsades de pointes) is a dangerous complication of cardiac arrest, regardless of use of TTM, and is associated with significant mortality for post cardiac arrest patients [24, 25]. Similar to the changes observed in VEB prevalence, the number of defibrillations was significantly higher in patients who developed MA [24]. Additionally, patients with MA had longer time to ROSC, which has also been shown as a predictor of outcome [24, 26]. The rate of MA did not vary with target temperature but was correlated with more aggressive decrease in body temperature in the first 6 hours of treatment [24]. This follows other studies which have suggested rate of temperature decline, and thus strength of heat homeostasis, as a possible predictor of mortality and outcome [24, 26]. The use of vasopressors was associated with post resuscitation ventricular arrhythmias, potentially showing an avenue to identify high-risk patients [23].
Electrolyte changes, which are known to predispose patients to arrhythmias outside of TTM, are common during TTM and have been proposed as a possible causative factor of arrhythmias, though the data on this remains unclear. Abnormal potassium levels are common during TTM, with both hypokalemia and hyperkalemia being reported during all stages of TTM (86% and 32% respectively) [27]. There does not appear to be an association between hypokalemia and ventricular arrhythmias. A trend between hypokalemia and MA was noted in one study, though not statistically significant [24], and multivariable regression showed no association between hypokalemia or hyperkalemia and recurrent ventricular arrhythmias or poor neurologic outcomes [27]. Interestingly, hypokalemia was associated with decreased odds of death prior to hospital discharge in one study, potentially pointing toward hypokalemia as a protective mechanism by the body [27]. The rate of decline in potassium levels in the first 12 hours of treatment is linked to an increased rate of MA, consistent with the effects of temperature decline rate, which may serve as a potential predictive factor [27]. Glycemic changes are also commonly observed during TTM. Hyperglycemia was observed in 45.6% of patients, though no significant impacts on neurologic outcome were observed as a result [8]. Hypoglycemia, on the other hand, was associated with poor neurologic outcome and was observed in 23% of patients indicating the need for aggressive management to avoid hypoglycemia [8].
When looking at the efficacy of TTM, it is important to understand the long-term effects of a hypothermic state on the body.Of significant consideration is the role of heat shock genessuch as Sirtuin 1; temperature dysregulation can alter Sirtuin 1 expression leading to chronic disease (insulin resistance, protein aggregation, autoimmune disease in non-alcoholic fatty liver disease (NAFLD) and several neurodegenerative diseases). Further investigation is needed to understand if acute treatment with TTM qualifies as “temperature dysregulation” with the connotation that TTM altersthe expression of heat shock genes, subsequently increasing the risk for the aforementioned chronic diseases [28].
Controlling for the multitude of adverse effects seen in TTM administration remains a significant challenge. Attempts to control for and isolate these effects through investigation is difficult, as many AE are multifactorial in causality. For example, neurologic injury has shown to be a predictive factor of poor neurologic outcome [24]. In the referenced literature, anticonvulsants were administered following the incidence of seizure (a known cause of neurologic injury), but the benefits of their use is unclear due to the inability to isolate anticonvulsant use and seizure. [8]. Delineation of the effects of anticonvulsants on neurologic outcome is necessary before making further conclusions towards their effectiveness. Nonetheless, anticonvulsants may provide a potential avenue for further investigation. Given the association between increased rate of decline in serum potassium levels and MA [27], investigation into the use of prophylactic antiarrhythmics in the subset of patients with rapid decline may prove insightful. Many of these associated risks are acceptable considering the substantial benefit TTM has been shown to provide. Secondary to the fact that the origins of the AE are multifactorial, it is important to further investigate where in the pathway TTM is contributing to, and/or causing these AE. Identifying the underlying mechanisms resulting in poor functional outcome and poor neurologic outcome poses the greatest potential for the future of TTM. By understanding/isolating the underlying mechanisms of the associated AE, further recommendations for TTM can be made. Arguably, the future of TTM resides in the ability to administer a “high quality” TTM with early initiation, well-controlled pharmacologic management, a specific target temperature in the cooling phase with a prolonged rewarming phase and avoidance of fever after TTM [7].Through further investigation of the adverse effects of TTM, we can begin to tighten the parameters of TTM to maximize its benefit to patients.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
