AUCTORES
Globalize your Research
Chat with us
Case Report | DOI: https://doi.org/10.31579/2693-4779/223
1University of Sarajevo, Faculty of Medicine
2Clinic for Paediatric Surgery, Clinical Center of the University of Sarajevo
3Clinic for Abdominal Surgery, Clinical Center of the University of Sarajevo
4Clinic for Anesthesiology and Reanimatology, Clinical Center of the University of Sarajevo
5Pediatric Clinic, Departement for Hematology, Clinical Center of the University of Sarajevo
*Corresponding Author: K.Karavdić, Clinic for Paediatric Surgery, Clinical Center of the University of Sarajevo
Citation: C.Devantier-Du Plessis, K.Karavdić, S.Muhović,M.Salibašić, A.Mešić, L.Pilav, (2024), Innovative Management of Congenital Hereditary Spherocytosis: Combined Laparoscopic Cholecystectomy and Splenectomy in A Paediatric Patient, Clinical Research and Clinical Trials, 10(4); DOI:10.31579/2693-4779/223
Copyright: © 2024 K.Karavdić. 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: 28 July 2024 | Accepted: 20 August 2024 | Published: 10 September 2024
Keywords: combined; cholecystectomy; splenectomy; pherocytosis
Congenital Hereditary Spherocytosis (CHS) is an inherited dysfunction or a deficiency in one of the erythrocyte membrane proteins. It is an inherited form of haemolytic anaemia which is noted by the presence of spherical erythrocytes. This leads to increased fragility and haemolysis. This case report is based on an 8-year old girl with CHS. She presented with acute abdominal symptoms and was subsequently managed with a combined cholecystectomy and splenectomy. This strategy seeks to address both the frequent haemolytic crises and the presence of gallstones, ultimately providing an extensive management strategy for paediatric patients with CHS
CHS is the most common form of haemolytic anaemia for which a splenectomy is indicated. It is inherited in an autosomal dominant fashion with the prevalence in Western populations being 1 in 5000.1
It is characterised by dysfunction or a deficiency in one of the erythrocyte membrane proteins which results in spherical erythrocytes prone to haemolysis. Patients commonly present with the following; mild jaundice, splenomegaly, anaemia and gallstones.
A splenectomy and cholecystectomy both are pillars of treatment to alleviate haemolysis and prevent cholecystitis due to gallstones.2
Risks and benefits should carefully be assessed before either procedures are performed in patients with CHS. The main indication is symptomatic haemolytic anaemia. If gallstones coexist with spherocytosis, gallbladder removal should ensue. Drastic clinical improvement, despite persistent haemolysis, occur often after a splenectomy in patients with severe disease.3
This case report presents a case of an 8-year old paediatric patient who underwent a combined laparoscopic approach to address both splenomegaly and cholecystitis.
Case Presentation:
An 8-year old girl was admitted to the Clinical Centre of the University of Sarajevo (KCUS) with complaints of abdominal pain which has been last five days, followed by vomiting and loose stools for the past two days. The patient presented with fever which was reaching up to 38.9°C.
Her past medical history was significant for CHS. She required multiple blood transfusions to manage her anaemia.
Upon physical examination, the patient presented with pallor and jaundice as well as notable splenomegaly.
Laboratory investigations revealed an elevated C-reactive protein (CRP) of 286.6 mg/L, a white blood cell count of 28 x 10^9/L, hemoglobin of 74 g/L, hematocrit of 0.22, red blood cell count of 3.05 x 10^12/L, and platelet count of 478 x 10^9/L. Her liver function tests showed an AST of 20 U/L, ALT of 11 U/L and LDH of 281 U/L. Her total bilirubin was elevated at 115 µmol/L, with unconjugated bilirubin at 83 µmol/L.
An abdominal ultrasound revealed a distended gallbladder with an echogenic and thickened wall up to 4 mm. The intraluminal contents indicated calculous cholecystitis. Her spleen was significantly enlarged and measured approximately 177 mm in length. She also demonstrated signs of diffuse peritonitis, especially in the ileocecal region, with a
reactive appendix that suggested acute enterocolitis. There was a moderate amount of free fluid peri-splenically and inter-intestinally.
Initial Management:
Based on the severity of the patient’s symptoms as well as ultrasound findings, she was originally treated conservatively and scheduled for an appendectomy.
The treatment of the complicated appendicitis was a three-port laparoscopy mixed technique. This included; intra-corporeal ligation of the appendix vermiformis artery, extracorporeal trans-umbilical ligation of the appendix and the appendectomy.
Figure 1: Perforated appendicitis.
The patient was discharged on the seventh postoperative day. A multidisciplinary team which included haematologists, based on her recurrent need for blood transfusions and the presence of multiple gallstones, agreed on a combined elective splenectomy and cholecystectomy.
Pre-operative Preparation:
The patient received a Pneumovax vaccine 15 days before the scheduled surgery in order to mitigate the risk of postoperative infections.
Surgical Procedure:
Three months post-appendectomy the patient had undergone a combined laparoscopic cholecystectomy. This procedure was performed using five ports: a 10-mm umbilical port for the laparoscope, two 5-mm ports in the left and right upper quadrants, and two additional 5-mm ports for instrumentation.
Laparoscopic Cholecystectomy:
Trocar placement:
A 10-mm trocar was inserted under the umbilicus for the laparoscope. A 10-mm trocar was placed in the epigastrium. Two 5-mm trocars were inserted in the right upper quadrant (Figure. 2).
Figure 2: Trocar placement for the cholecystectomy.
Procedure:
After careful identification of the cystic duct and artery, both these structures were clipped (Figure.4). There after the gallbladder was dissected from the liver bed using electrocautery (Figure. 5). The gallbladder was removed through the umbilical port.
Figure 3: Distended gallbladder prior to removal.
Figure 4: Identification of cystic duct and artery
Figure 5: Clipped cystic duct and artery and resection of gallbladder from the liver bed.
Figure 6: Resected area without gallbladder.
Laparoscopic Splenectomy:
Trocar placement:
The patient was rotated 45° degrees onto her side (Figure. 7). Additional ports were placed to facilitate the mobilisation as well as the removal of the spleen:
A 5-mm trocar was placed in the left upper quadrant. Another 5-mm trocar was placed in the left lower quadrant.
The exact placements for the five-port splenectomy were as follows:
Umbilical Port (10 mm): For the laparoscope, placed below the umbilicus.
Epigastric Port (10 mm): Midline, about 1 cm below the xiphoid process.
Left Upper Quadrant Port (5 mm): Approximately 5 cm below the costal margin, anterior axillary line.
Right Upper Quadrant Port (5 mm): Mid-clavicular line, below the costal margin.
Left Lower Quadrant Port (5 mm): Midway between the umbilicus and left iliac crest, anterior axillary line.
Figure 7: 45° rotation of patient onto side with tracer placement for splenectomy.
Procedure:
Following the cholecystectomy, the focus was shifted towards the spleen. The spleen was mobilised by dividing the splenocolic ligament followed by the short gastric vessels (Figure. 9). The splenic hilum was carefully dissected (Figure. 10). The splenic artery and vein were both clipped and divided (Figure. 11). Adhesiolysis was meticulously performed to dissect and separate fibrous adhesions between the spleen and adjacent structures to ensure the safe removal of the spleen. (Figure 12.) The significantly enlarged spleen was
attempted to be extracted through the umbilical port. However, due to the unavailability of the correct specimens bag an incision was made from where the umbilical port had been placed to where the 5mm left lower quadrant quadrant port had been placed and thus the spleen was finally extracted using an open splenectomy. (Figure 13).
The entire procedure lasted 120 minutes. A drain was placed in the splenic bed and was removed on the second post-operative day.
Figure 8: Enlarged spleen in anatomical position
.
Figure 9: Splenocolic ligament with short gastric vessels
Figure 10: Dissection of splenic hilum.
Figure 11: Clipped and divided splenic artery and vein.
Figure 12: Adhesions dissected and separated.
Figure 13: Cavity after spleen had been resected.
Figure 14: Spleen extracted through open splenectomy.
Figure 15: Extracted spleen measuring 177cm in length.
Figure 16: Surgical drain inserted and post operative result.
Post-operative course:
The patient’s post-operative course was satisfactory and she was mobilised on the first post-operative day. She tolerated oral intake well. A
haematological follow-up revealed no signs of jaundice or anaemia. The patient remained stable and was discharged on the fifth post-operative day.
Figure 17: Fifth post-operative day result, day of discharge.
In paediatric patients a combined laparoscopic cholecystectomy and splenectomy approach in
the management of CHS is a strategic and beneficial method. It coincides with the well-documented advantages of laparoscopic surgery, incorporating a faster return to normal activities, minimal trauma, and reduced postoperative pain.4
Laparoscopic procedures have expanded in numerous surgical fields due to these benefits. The first case of laparoscopic splenectomy, reported by Delaitre and Maignien,5 lay the groundwork for its widespread adoption in treating hematologic diseases. Thus, laparoscopic splenectomy has now become the gold standard for elective hematologic spleen diseases.This includes cases of splenomegaly. It is safely performed at several referral centres.
Cholelithiasis is often associated with splenic disorders in patients who are in need of a splenectomy. However, reports on a combined laparoscopic splenectomy and cholecystectomy are scant. There is also limited data on the specific outcomes of these concurrent procedures. It is pivotal to understand the feasibility as well as safety of these combined surgeries. Especially when advocating for prophylactic splenectomies during cholecystectomies in patients with CHS. Not performing a prophylactic splenectomy during cholecystectomy for cholelithiasis could ultimately lead to an 18% lifetime risk of subsequent therapeutic splenectomy for these patients.6
The technique for these combined procedures varies in the literature as there are differences in the order of operations as well as patient positioning. For example, Yamagishi and Watanabe,7 reported a method involving a 1-cm incision below the umbilicus for the laparoscope and three 5-mm trocars in the sub-xiphoid and subcostal regions. After securing the splenic hilum, the spleen was removed through an enlarged umbilical incision. A cholecystectomy was then performed in a standard laparoscopic manner.
Sasaki et al.8 used a 4-trocar technique for a laparoscopic splenectomy in a semi-lateral position. This was followed by a cholecystectomy in the supine position. They emphasised a careful dissection to avoid any pancreatic injury. They also used a retrieval bag for the excised spleen.
In Nobili et al.'s series,9 they first performed a cholecystectomy with the patient in the supine position, followed by a splenectomy in a semi-lateral position. They used the 5-trocar technique, which provided a good view of the operative field. This approach also facilitated with the dissection and ensured no complications. This aligns with the technique used in our case, where the combined approach proved effective and safe. Ultimately resulting in minimal postoperative complications and a satisfactory and short recovery.
Blood loss and conversion rates are critical metrics in evaluating the success of any procedure, especially in a joint cholecystectomy and splenectomy. Nobili et al. reported blood loss ranging from 10 to 700 mL, with a mean of 40 mL, and a conversion rate of 3% to 8%.9 In our series, the blood loss was minimal. The patient also dud not require a blood transfusion. The conversion rate was 8.3%, comparable to literature data.
Operative times for combined procedures such as a cholecystectomy and splenectomy usually range from 70 to 300 minutes, with increased experience reducing the mean operative time to approximately 100 minutes. Hospital stays typically range from 3.5 to 15 days.10 Our patient had a postoperative stay of 5 days, aligning with these findings.
Portal vein thrombosis (PVT) is an extreme and severe complication post-splenectomy, especially in patients with thrombocytosis, splenomegaly, and congenital thrombophilia disorders. Laparoscopic surgery might increase the risk of PVT due to pneumoperitoneum but could also prevent it by minimising postoperative coagulation changes.11 With our patient no signs of PVT were reported.
This case highlights how pivotal a multidisciplinary approach is in managing complex cases of CHS. A successful cholecystectomy and splenectomy provided an all-encompassing solution to the patient’s haematological and biliary pathology. The importance of laparoscopic surgery in simultaneously treating gallbladder complications and ailments as well as those of the spleen in a single operation should be emphasised. These integrated procedures not only reduce overall morbidity but also optimise recovery, accentuating the importance of this approach in paediatric patients with CHS. Further studies as well as long-term follow-ups are essential to validate the benefits and safety of this combined surgical approach in the paediatric population.
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
