AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/2639-4162/093
1 Department of Surgery, Enugu State University Teaching Hospital, Enugu, Nigeria.
2 Department of Opthalmology, Enugu State University Teaching Hospital, Enugu, Nigeria.
*Corresponding Author: 10.31579/2639-4162/093
Citation: Chukwubuike K. Emeka, Okoloagu Nkiruka, Anijunsi L. Patrick, (2023), Frequency of Intestinal Repair Leak Following Repair of Enteric Perforation in Children: A Single Surgeon’s Experience, J, General Medicine and Clinical Practice. 6(2); DOI:10.31579/2639-4162/093
Copyright: © 2023 Chukwubuike Kevin Emeka. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 26 February 2023 | Accepted: 06 March 2023 | Published: 07 March 2023
Keywords: children; frequency; intestinal; leakage; repair; typhoid perforation
Background: Enteric(intestinal) perforation causing peritonitis is a common surgical emergency in children and surgical repair is necessary. However, there may be complications accompanying the repair which may include leak from the repair site. The aim of this study was to evaluate the frequency of leak of intestinal contents after repair of enteric perforation.
Materials and Methods:
This was a retrospective study of children who were operated upon for intestinal perforation at the pediatric surgery unit of a teaching hospital in Enugu, Nigeria. The study covered a 5-year period. The information extracted included the age of the patient at presentation, gender, duration of symptoms before presentation, time interval between presentation and surgery, etiology of the perforation (intra-operative finding), operative procedure performed, post-operative complications (including evidence of repair leak), duration of hospital stay and outcome of treatment.
Results:
A total of 112 cases of enteric perforations were repaired during the study period. There were 70 (62.5%) males and 42 (37.5%) females. Typhoid intestinal perforation and primary closure/repair were the most common cause and operative treatment rendered to the patients respectively. Leakage of intestinal contents from the repair site occurred in about one-third of the patients. The overall outcome was fair; however, mortality happened in about 5 percent of the patients due to overwhelming sepsis.
Conclusion:
Surgical repair of intestinal perforation in children may be achieved by primary closure or a resection and anastomosis. Howbeit, this intestinal repair may be complicated by leakage of intestinal contents. Typhoid intestinal perforation was the most frequent cause of enteric perforation in the index study.
Enteric (intestinal) perforation causing peritonitis is a common surgical emergency in developing countries since time immortal [1]. Statistically, enteric perforation has been postulated to account for the fifth most common cause of abdominal emergencies due to the high incidence of typhoid fever [1]. Historically, enteric perforations have been found in Egyptian mummies [1]. The pathogenesis of intestinal perforation is explained by the fact that the disease extends through the full thickness of the intestinal wall. The etiologies of intestinal perforations could be from bacterial infections (eg., salmonella, tuberculosis); viral infection (eg., human immunodeficiency virus); fungal infection (eg., Entaamoeba histolytica). Other causes include drugs include NSAIDS such as ibuprofen. In low income countries, enteric perforation (mostly ileal) results as a complication of typhoid fever which is a public health problem in developing countries [2]. It is noteworthy to state that in some cases the cause of the intestinal perforation is not known and such situations are called non-specific intestinal perforation [3]. The consequence of intestinal perforation is the flooding of the peritoneal cavity by aerobic and anaerobic organisms causing peritonitis. The options of operative treatment of intestinal perforation may include primary repair/closure of perforation, primary ileostomy or resection and anastomosis [1]. Despite the various modalities of treatment, intestinal perforation is still associated with high morbidity and mortality. The aim of this study was to evaluate the frequency of leakage of intestinal contents after repair of enteric perforation. For the purposes of this study, only clinically obvious leaks were considered. What is the clinical benefit of this study? This study will help establish the guidelines for the optimal management of the children with enteric perforations.
This was a retrospective study of children who were operated upon for enteric perforation at the pediatric surgery unit of Enugu State University Teaching Hospital (ESUTH), Enugu, Nigeria. The study covered a 5-year period, from January 2017 to December 2021. The diagnosis of typhoid intestinal perforation was made based on clinical features, investigations and intra-operative findings. On presentation at the children emergency room, the patients were resuscitated and stabilized using intravenous fluids and antibiotics. A nasogastric tube and urethral catheter were passed to decompress the upper gastrointestinal tract and monitor urine output respectively. Electrolyte imbalances, if any, were corrected. Following adequate resuscitation and under general anesthesia with endotracheal intubation, laparotomy was performed with the access through a transverse abdominal incision. The bowel perforation was identified and the surgeon closes the perforation primarily, performs an ileostomy or resection and anastomosis. The peritoneal cavity was cleaned out and the abdomen closed in layers. Patients who have had laparotomy for the same pathology at a peripheral hospital before referral to ESUTH for reoperation and patients with incomplete case records were excluded from this study. ESUTH is a tertiary hospital located in Enugu, South East Nigeria. The hospital serves the whole of Enugu State, which according to the 2016 estimates of the National Population Commission and Nigerian National Bureau of Statistics, has a population of about 4 million people and a population density of 616.0/km2. The hospital also receives referrals from its neighboring states. Information was extracted from the case notes, operation notes, operation register, and admission-discharge records. The information extracted included the age at presentation, gender, duration of symptoms before presentation, time interval between presentation and surgery, etiology of the perforation (intra-operative finding), operative procedure performed, post-operative complications (including evidence of repair leak), duration of hospital stay and outcome of treatment. The period of follow up was for 12 months. Ethical approval was obtained from the ethics and research committee of ESUTH. Statistical Package for Social Science (SPSS) version 21, manufactured by IBM Cooperation Chicago, Illonois, was used for data entry and analysis. Data were expressed as percentages, median, mean, and range
3.1. Patient’s demographics
A total of 112 cases of enteric perforations were surgically repaired during the study period. There were 70 (62.5%) males and 42 (37.5%) females which correspond to a male female ratio of approximately 1.7:1. The ages of the patients ranged from 3 to 14 years with a median of 10 years. The median duration of symptoms prior to presentation to the hospital was 7 days (5 – 8). The median duration from presentation to surgery was 2 days (range: 1 - 4). The mean duration of hospital stay was 14 days (range 10-27).
3.2. Etiology of the perforation (intra-operative finding)
The causes of the enteric perforation as found intra-operatively are shown in Table 1.
Table 1: Etiology of enteric perforation
Table 2: Operative procedures carried out
3.4. Post-operative complications (including evidence of repair leak)
Among the 98 patients that had repair/anastomosis, 32 (32.7%) patients had leakage of intestinal contents from the repair site. This number excludes patients that had primary ileostomy. Other post-operative complications include surgical site infection in 15 (13.4%) patients, suture related complication in 6 (5.4%) patients and abnormal scars in 3 (2.7%) patients.
3.5. Outcome of treatment
Overall, all the patients achieved good recovery except for 6 (5.4%) patients that expired. The mortalities were due to severe sepsis and respiratory failure. Patients that had intestinal leaks were taken to theatre and secondary ileostomy performed.
Primary closure/repair of intestinal perforation is one of most performed surgical procedures in children [4]. The high incidence of intestinal perforations in low income ecountries could be related to lack of clean drinking water and poor sanitary conditions. Bowel perforation from any etiology is a serious abdominal emergency. Historically, since the late 1880s, appropriate treatment for intestinal perforation especially in typhoid intestinal perforation has remained controversial [5]. Surgery is the established modality of treatment of enteric perforation around the turn of the century [5]. However, it is worthy to note that there are reports of recovery of a few patients with enteric perforation who were treated only with antimicrobial agents. Currently, the recommended therapy for enteric perforation is always surgical which consists of simple closure and peritoneal irrigation [5].
In the present study, over a hundred enteric perforations were repaired. This number of enteric perforations is consistent with the report of Chalya et al [6]. This high number of intestinal perforations could be explained by the large number of typhoid intestinal perforations seen in developing countries like Nigeria and Tanzania. More male were affected by the enteric perforations. This male predominance is in line with the reports of other series on intestinal perforation [6, 7]. However, there is no established genetic basis for the male predilection and intestinal perforation is not gender related. The median age of the patients with enteric perforation is 10 years. The setting of the study and common predominant causes of enteric perforations in children may explain this median age. For instance, penetrating abdominal injuries from trauma may be more common in conflict areas while typhoid perforation from salmonella may be more in unhygienic food/water consumption and in untidy environments. Delay in presentation to the hospital is a frequent occurrence in low income countries. Poverty, ignorance and lack of awareness have been implicated in these delayed presentations. The clinical significance of this late presentation is that it impacts negatively on overall outcome of treatment. The two days lag period before surgical intervention is the interval required for resuscitation, stabilization and optimization of the patients. The entire duration of hospitalization refers to the overall time required for care, healing and recovery of the patients. This duration of hospital stay may be related to the etiology of the enteric perforation, premorbid condition of the patient and extent of operative procedure performed.
In the index study, typhoid intestinal perforation was the most common cause of intestinal perforation. Typhoid intestinal perforation is one of the surgical complications of typhoid fever. Typhoid fever is multisystem infection caused by the bacteria, Salmonella enterica serovar typhi and Salmonella enterica serovar paratyphi A and B which are transmitted through feco-oral route by ingestion of contaminated food and/or water [8]. The pathogenesis of typhoid intestinal perforation is the ulceration of the Peyer’s patches at the terminal ileum resulting in bowel perforation. This perforation leads to leakage of intestinal contents into the peritoneal cavity [9]. Chukwubuike et al reported intestinal perforation by salmonellosis as one of the most common causes of intestinal perforation in children in Enugu, Nigeria [10]. Prevention of typhoid infection can be achieved by provision of potable drinking water and proper waste disposal.
Tuberculous intestinal perforation was the second most common cause of enteric perforation in the current study. Tuberculous intestinal perforation results from intestinal involvement by mycobacterium tuberculosis. It is a public health problem in developing countries and its incidence is rising in western countries due to immigration and human immunodeficiency virus infection [11]. Abdominal tuberculosis can affect the peritoneum, intestine or lymph nodes and it occurs through reactivation of latent tuberculous infection or by ingestion of tuberculous mycobacteria (as with ingestion of unpasteurized milk or undercooked meat) [12]. Treatment of tuberculous intestinal perforation could be by primary closure or by resection and anastomosis. However, it is been postulated that primary resection of the affected intestine and anastomosis is the treatment of choice for tuberculous intestinal perforation [12].
Abdominal trauma is an infrequent occurrence in children except during times of civilian or military conflict. Blunt or penetrating abdominal trauma may cause intestinal perforation and/or can sever the vessels in the intestinal mesentery. It is worthy to note that occasionally intestinal perforation of unknown etiology can occur. Primary repair/closure of enteric perforation was the most frequently surgical procedure in our patients. The large number of typhoid intestinal perforations and the simplicity of primary closure may explain the numbers. However, in a background of gross peritoneal contamination where primary closure of enteric perforation is not advised, an enterostomy (eg., ileostomy) may suffice.
About one-third of the patients experienced a leak following repair of the enteric perforation. One study from Peshawar, Pakistan reported anastomotic leak in about one-fifth of their patients [4]. The cohort of patients recruited into a particular study may determine the frequency of the intestinal leak. For instance, there may be differences in anastomotic leaks in adults when compared to children. Again, the disease causing the problem may also affect the frequency of the perforation. The rate of anastomotic leak may also be related to the part of the bowel where the repair was performed. For instance, there may be more perforations in the small intestine when compared to the large intestine. The vascularity and consistency of the intestinal contents may also account for the disparities in the rates of leakage.
Surgical repair of intestinal perforation in children may require primary closure or a resection and anastomosis. Howbeit, this intestinal repair may be complicated by leakage of intestinal contents. Typhoid intestinal perforation was the most frequent cause of enteric perforation in the index study
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.
