AUCTORES
Globalize your Research
Case Report | DOI: https://doi.org/10.31579/2693-2156/045
1 Fellow Gastroenterology, University of Caldas.
2 Medical Specialist in Gastroenterology, University of Caldas.
3 Gastroenterology Postgraduate Coordinator, University of Caldas, Union of Surgeons.
4 General Physician. San Martin University, Sabaneta.Antioquia.
*Corresponding Author: Christian German, Fellow Gastroenterology, University of Caldas.
Citation: Christian German., Ospina Pérez., Andrés Valencia Uribe., Lázaro Arango Molano., Rosa María Ospina Pérez., (2023), Black Esophagus In Critical Patient, J Thoracic Disease and Cardiothoracic Surgery, 4(2); DOI:10.31579/2693-2156/045
Copyright: © 2023 Christian German. 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: 27 February 2023 | Accepted: 03 March 2023 | Published: 10 March 2023
Keywords: restrictive cardiomyopathy; endomyocardial fibrosis; heart failure cardiac surgery; hypereosinophilia; cardiac magnetic resonance
Background: Endomyocardial fibrosis (EMF) is a grim disease. It is the most common restrictive cardiomyopathy worldwide,1 but its exact etiology and pathogenesis remain unknown. It seems likely that dietary, environmental, and infectious factors may combine in a susceptible individual to give rise to an inflammatory process leading to endomyocardial damage and scar formation. 2 An extensive ventricular endocardium fibrosis distorts ventricular architecture and leads to a restrictive physiology. Impaired filling and valvular insufficiency define the disease.1 Many times it is associated to hypereosinophilic endocarditis. This tropical cardiomyopathy presents most cases in Africa, Asia, and South America.2
Case presentation: We present a 67-year-old male patient with restrictive cardiomyopathy and mitral valve insufficiency due to EMF. The patient was referred a history of schistosome infection in the childhood. He has presented no other risk factors described in the literature. After treatment with diuretics and vasodilators, he underwent a successful surgical resection of endocardial ventricular fibrosis, mitral valve replacement and two saphenous bypasses.
Conclusions: The aim of this case report is to highlight the disease and to show how challenging is the endomyocardium fibrosis’s treatment and the importance of an earlier diagnosis as well as more researches on this topic.
Previously known as "Davies disease”, EMF is the most frequent restrictive cardiomyopathy worldwide with higher prevalence in sub-Saharan Africa, Asia, and South America, responsible for 10-20% of deaths by heart failure in Africa. [1,3,4] It is a chronic and insidious disease responsible for endocardial thickening, cardiac morphological modifications, reduced ventricular complacency and heart failure. Fibrous infiltrates deposit in the ventricular apex and increase atria size due to severe diastolic dysfunction and restrictive ventricular disorder. [4,5] A study conducted in Mozambique based on a sample of 1.063 individuals estimated EMF's global prevalence of 19,8%, affecting predominantly males between 10-19 years with biventricular involvement. 22% of the affected patients presented symptoms.[6]
EMF is a restrictive cardiomyopathy characterized by reduced ventricular complacency and diastolic dysfunction due to deposition of fibrous tissue in the endomyocardium, manifesting symptoms of heart failure.[1,2] EMF is a neglected disease and its insidious expression often leads to a late diagnosis and a poor prognosis.[2] While the physiopathology remains unclear, EMF is recurrently associated to chronic eosinophilia what permits to consider endemic parasitosis (schistosomiasis, filariasis, malaria, and helminths) as a potential trigger. Other triggers would be genetics, autoimmune or nutritional due to the higher prevalence in tropical low-income countries.[2]
Case Presentation:
A 67-year-old male patient was admitted to the hospital due to decompensated heart failure.
The patient was referred a history of progressive dyspnea triggered by less than ordinary activities and lower-extremity edema throughout 1 year. He denied hypertension, dyslipidemia, diabetes, chest pain, myocardial infarction or stroke. The patient reported schistosome infection in the childhood. All his laboratory tests were normal.
A cardiac magnetic resonance imaging (MRI) revealed apical left ventricle wall thickening with left ventricular apical obliteration associated with enlargement of the respective atrium. Delayed enhancement imaging showed endomyocardium enhancement involving left ventricular apex, mitral valve regurgitation due to annulus dilation and a thrombus at left ventricular apex. (Figure 1) (Figure 2)
Figure 1: Cardiac MRI showing obliteration of the entire left ventricular apex.
Figure 1: Cardiac MRI showing obliteration of the entire left ventricular apex.
Figure 2: Delayed enhancement revealing endomyocardial fibrosis in the apical portions of all the left ventricle walls.
The coronary angiography showed severe lesion in the right coronary artery and in anterior descending artery.
The final diagnosis was left ventricle endomyocardium fibrosis (EMF), mitral valve insufficiency, thrombus at left ventricular apex and coronary artery insufficiency.
After a multidisciplinary consideration, surgical treatment was indicated. The patient was submitted to a cardiac surgery with cardiopulmonary bypass by median sternotomy, aortic, superior and inferior vena cava cannulation and anterograde cardioplegia. The procedure was done without problems and the patient was sent to the intensive care unit (ICU) using low doses of norepinephrine and dobutamine to improve cardiac function. The drugs were required in low dose for 5 days, the patient had a good outcome and was discharged from the ICU in 7 days. He was discharged from hospital 11 days after surgery.
The postoperative control transthoracic echocardiography showed a normal functioning mitral valve, without obstruction of the left ventricle outflow tract.
Tissue fragments recovered at cardiac surgery showed the endocardium thickening and fibrous extend into the underlying myocardium with calcified areas of left ventricle and septum.
Histologically the endomyocardium and mitral valve fragments presented areas of fibrosis, hyalinization and vascular tissue neoformation, multiple foci of mononuclear inflammatory infiltrate, and calcification areas. The biopsies were compatible with the diagnostic suspicion (endomyocarium fibrosis).
Previously known as "Davies disease”, EMF is the most frequent restrictive cardiomyopathy worldwide with higher prevalence in sub-Saharan Africa, Asia, and South America, responsible for 10-20% of deaths by heart failure in Africa.[1,3,4] It is a chronic and insidious disease responsible for endocardial thickening, cardiac morphological modifications, reduced ventricular complacency and heart failure. Fibrous infiltrates deposit in the ventricular apex and increase atria size due to severe diastolic dysfunction and restrictive ventricular disorder.[4,5] A study conducted in Mozambique based on a sample of 1.063 individuals estimated EMF's global prevalence of 19,8%, affecting predominantly males between 10-19 years with biventricular involvement. 22% of the affected patients presented symptoms.[6]
Many theories have been proposed to explain the etiopathogenesis of EMF, as viral infections, allergies associated with eosinophilia and autoimmune reactions, malnutrition and exposure to toxic chemicals. The relation between EMF and Loeffler syndrome (in which eosinophils gather in the pulmonary tissue in regards to a parasitic infection) and the prevalence of parasitosis in endemic countries strengthened the association between eosinophilia and myocardial lesions.[2] Approximately 40 to 50% of patients with eosinophilic syndrome develop heart conditions, such as Loeffler's endocarditis, in which the hypereosinophilic reaction is responsible for fibrosis and necrosis of the endocardium and leads to endomyocardial fibrosis.[7] However, this theory is limited by geographic inconsistency with important parasitic prevalence and insignificant difference in parasitic loads when comparing the control group to EMF patients.[2,4,8] More studies are needed to reassure a strong scientific base towards EMF’s etiology.
Early stages usually manifest with fever, pancarditis, dyspnea, itching, and periorbital swelling.2 Eosinophilia can be present mainly during the early stages of EMF.[9]
Abnormal increase of collagen deposition, specially type-1, and proliferation of fibroblasts cause myocardial rigidification and diastolic ventricular dysfunction.[3] If tendinous cords and papillary muscles are also affected, atrioventricular valve regurgitation can occur. Atrial fibrillation, conductive disorders and ventricular arrhythmias are detected in the electrocardiogram in 30% of cases. [5,10] The first necrotic stage called inflammatory phase is followed by mural thrombi generation and the risk of thromboembolic complications. Endocardial calcification and valvar incompetence are common in the final stage.[11] Symptomatic heart failure is treated with diuretics, vasodilators and beta-blockers, depending on the disease presentation.
A score was developed by Mocumbi and col. in 2018 to guide EMF’s patient’s diagnosis and prognosis.[5,6] The presence of two major criteria or one major and two minor criteria is considered as a diagnostic proof of the disease. The prognosis is based on the scores, being poor when ≥ 15 points and better if < 8>
EMF’s diagnosis can be guided by echocardiographic evidences of thrombotic and fibrotic obliteration of the ventricular apex, increase of the endocardial diameter and valvar insufficiency.[5,12] Differential diagnosis with other restrictive cardiomyopathies is substantial for the treatment’s guidance and can be better achieved by cardiac MRI using gadolinium-based contrast. MRI provides accurate morphological evaluation by assessing diastolic and systolic functions, tissue characterization and stratifying prognosis of most cardiomyopathies. Delayed enhancement imaging helps to identify the presence of fibrosis.[7]
In this case we presented a patient that was classified as NYHA III - New York Heart Association Classification of Heart Failure (comfortable at rest; less than ordinary physical activity causes fatigue, dyspnea, palpitations) and who had poor response to pharmacological treatment. He was in the final stage of the disease and the left ventricular endomyocardium was replaced by fibrosis, as well as the mitral valve tendinous cords. The final result was a restrictive dilated cardiomyopathy and mitral valve incompetence. Superimposed thrombosis and endocardial calcification were present.
To improve his clinical condition the endomyocardial resection and valve replacement were performed after a multidisciplinary consideration, aiming to increase the end systolic and diastolic diameter and to avoid left ventricle diastolic dysfunction.
There is no specific drug therapy for EMF. Surgical intervention is reserved for more advanced cases (patients graded NYHA functional classification III and IV) as it has a high postoperative mortality.[4,5] If the left ventricle is affected, the severity of the mitral insufficiency and pulmonary hypertension establish surgical indication.[12] Despite the fact that Right ventricular EMF is the most common site of presentation either in isolation or as part of the biventricular disease, our patient had a Left ventricular form of the disease. Involvement of both ventricle, right ventricle fibrosis, and tricuspid or mitral regurgitation is associated with a higher mortality rate. Ascites is observed in half of cases of EMF and it is associated with greater involvement of the right ventricle or a longer duration of the disease. It defines a worse prognosis. The ascites without peripheral edema appears to be caused by peritoneal inflammation with increased sequestration of fluid as well as fibrosis with decreased reabsorption.[13]
Surgical intervention is expected to increase the survival when is undertaken before the development of irreversible cardiac and hepatic damage. It requires experienced operators and well-equipped cardiac facilities.[14]
The imaging techniques progress, detecting myocardial damage, contribute to earlier diagnosis and survival in EMF patients.[14] Surgical intervention, in a less advanced stage of the disease, may improve quality of life and prognosis of the patient, but it is not curative.[14,15]
Drugs that block different pathways of eosinophilic inflammation altering immunologic mechanism of hypereosinophilic syndromes make the monoclonal antibody Imatinibe a promising potential treatment for EMF, but they are ineffective when the heart failure is present.[5]
The EMF remains a challenging disease, it is mandatory a better comprehension of its physiopathology to find answers for its treatment.
List of Abbreviations
Endomyocardial fibrosis - EMF
Magnetic resonance imaging - MRI
Intensive care unit - ICU
New York Heart Association - NYHA
Declaration
We declare for whom it may concern that written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
We also confirm that the disclosed information is correct and that no
other situation of real, potential or apparent conflict of interest is known to us.
We confirm that we do not have a financial or other interest in the subject of the work
we wrote, which may be considered as constituting a real, potential or apparent
Conflict of Interest.
We also afirm that we have not received any funds to write the: " Left ventricle endomyocardium fibrosis - a case report".
Every author contribute to make this article and all of them are responsible for writing the paper.
Ethical Approval
This study was approved by the Ethical Committee of Cardiovascular Department of Biocor Institute, Nova Lima , Minas Gerais, Brasil.
Availability of data and materials
Every data and materials’ statement can be found in our institution archives and in the bibliographic references cited in the text.
Competing interests
The authors declare that they have no competing interests.
Funding
The authors declare that they have no sources of funding for the research
Author’s contributions
MF, LF, ESF analyzed the surgery indication and the clinical evolution. JVG, VD, MD analyzed the patient’s images and laboratorial tests. RRS, SZ, MCA were major contributor in writing the manuscript. All authors read and approved the final manuscript.
Acknowledgements
Not applicable
Consent for Publication
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
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.
