AUCTORES
Globalize your Research
Review article | DOI: https://doi.org/10.31579/2641-5194/001
Jangaon Institute of Pharmaceutical Sciences, Depot. Of Pharmaceutics, Jangaon, India.
*Corresponding Author: Jangaon Institute of Pharmaceutical Sciences, Depot. Of Pharmaceutics, Jangaon, India. e-mail: swathigoli45@gmail.com
Citation: Swathi Goli. Peptic Ulcer Disease: Maintenance treatment with H2 blockers. J. Gastroenterology Pancreatology and Hepatobilary Disorders. 1(1) Doi: 10.31579/2641-5194/001
Copyright: © 2017 Swathi Goli. 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: 08 December 2017 | Accepted: 26 December 2017 | Published: 30 December 2017
Keywords: peptic ulcer disease; helicobacter pylori; nonsteroidal anti-inflammatory drugs; eradication treatment
Peptic ulcer disease (PUD) is a prevalent disease, it affecting around 5-10% of the general population worldwide, but with notable regional and racial variations. The two most common etiological causes are the chronic infection with Helicobacter pylori (Hp) and the use of non-steroidal anti-inflammatory drugs (NSAIDs). Its diagnosis is based mainly in the endoscopy and the active search of concomitant Hp presence. The discovery of the link between H. pylori and peptic ulcer has changed dramatically its management, because it has become a curable infectious disease.
The eradication therapy of is the best choice to achieve the final cure of PUD in infected patients. Several current international recommend a standard triple therapy as first-line therapy, including a proton pump inhibitor and a combination of amoxicillin and clarithromycin. This combination therapy has shown a decreased efficacy over the years. The main reason is increasing antibiotic resistance, particularly to clarithromycin and metronidazol, of certain Hp strains. Several new treatment options or modifications of already established regimens have been introduced in last years, to overcome these treatment failures.
For the subgroup of patients with H. pylorinegative ulcers, avoiding NSAIDs intake also has a clear influence in evolution of the disease and in some cases drives to the complete healing of the peptic ulcer. In refractory or recurrent cases, continuous therapy with anti-secretory agents and/or the replacement of conventional NSAIDs by selective drugs for inhibition of cyclooxygenase-2 (COX-2) are useful treatment options.
Peptic ulcer (PU) can be defined as the presence of a profound loss of substance affecting the mucosa of the stomach and/or duodenum, reaching beyond the muscularis mucosa, generally to the muscle layer due to the environmental gastric acid secretion.
The two most common etiological causes are the chronic infection with Helicobacter pylori (Hp) and the use of non-steroidal anti-inflammatory drugs (NSAIDs), including of course, the acetylsalicylic acid (ASA). There are other less common causes that can cause a PU, which are considered together, account for less than 5% of cases. Zollinger-Ellison syndrome or gastrinoma is one among them which is a neuroendocrine tumor, usually located at the head of the pancreas or in the duodenal wall, overactive and gastrin secretory (Table 1).
The goals of pharmacotherapy are to eradicate H pylori infection, to reduce morbidity, and to prevent complications in patients with peptic ulcers. Acid suppression is the general pharmacologic principle of medical management of acute bleeding from a peptic ulcer, using histamine-2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs). [38] Both classes are available in intravenous or oral preparations. Discontinuation of NSAIDs is paramount, if it is clinically feasible. For patients who must continue with their NSAIDs, PPI maintenance is recommended to prevent recurrences even after eradication of H pylori.
Epidemiology
The glandular parts of the stomach located in the antrum and fundic regions are responsible for secretion of the enzymes and gastric acid for digestion of food. The acid-secreting oxyntic cells or parietal cells in the fundic region are the main sites of gastric acid secretion. The regulation of the secretion of gastric acid is carried out by various hormones and neurotransmitters (Figure 1). The parietal cell secretion of acid is mediated by the primary modulator histamine (HA) which may be released when enterochromaffin-like (ECL) cells are stimulated by gastrin (released from G cells of the antrum) and acetylcholine (Ach) (released from enteric neurons). Stimulation of the vagus nerve is known to initiate the release of both gastrin and acetylcholine (ACh) from their respective sites.
Acetylcholine can also directly stimulate parietal cells to increase acid secretion. Gastrin is also capable of stimulating the proliferation of the parietal cells by a direct action. Acetyl choline, histamine and gastrin stimulate acid secretion by activating specific G-proteincoupled receptors on the basolateral membrane of the parietal cells. ACh and gastrin activate phospholipase C to catalyze the formation of diacylglycerol and inositol triphosphate from membrane bound phospholipids. The release of Ca2+ from intracellular stores and the subsequent increase in cytoplasmic calcium ions (Ca2+) activates H+ /K+ -ATPase enzyme system (gastric proton pump). The binding of HA to the H2 -receptor activates adenylate cyclase, resulting in an increase in cyclic AMP, which activates the proton pump [11]. The proton pump is thus, the terminal stage in gastric acid secretion, which makes it an ideal target for developing irreversible inhibitors of acid secretion.
Histamine exerts a strong stimulant action on the gastric acid secretion from the parietal cells by acting on histamine H2 -receptors. The H2 -receptor antagonists were the first class of drugs to demonstrate an effective reduction in acid secretion. The discovery of H2 -receptor antagonists revolutionised the field of treatment of peptic ulcer as these were not only effective at healing ulcers but also kept them in remission when given as maintenance therapy [Bianchi PG, Tam PK, Saing H, Collen MJ]. Early studies indicated that these agents could heal peptic ulcers in 60% to 85% of patients within 4 to 8 weeks, compared to 20% to 40% healing rates in the placebo group. [Thomas JM, Misiewicz G et al, Feldman M ]. Currently, there are four US-FDA approved H2 -receptor antagonists in market: cimetidine, famotidine, nizatidine and ranitidine. The advent of this class of drugs came in early 70s when Black et al [Black JW] reported the discovery of thiourea derivative burimamide, the prototypic agent from this class, which inhibited acid secretion based on the antagonism of the histamine-2 receptors. Despite its higher potency over commercially available anti-secretory agents at that time (anticholinergics), its introduction into therapy was hampered by its poor bioavailability.
The mechanisms through which the Hp favours the development of PU, are better known in the duodenal, than in gastric side. In patients infected with the bacteria, triggers an inflammatory and immunological response to the level of the gastric and duodenal mucosa, with release of number of pro-inflammatory cytokines such as IL-8 and TNF-α. Thus appears acute and chronic gastritis, which reduces the thickness and quality of mucus layer [8].
The most typical manifestation of the uncomplicated peptic ulcer is the presence of a burning or corrosive pain, mainly located at the epigastrium. Sometimes, it can be characterized as a vague abdominal pain, nausea, vomiting, diffuse discomfort, or may be perceived as a pressure or feeling of abdominal fullness or hunger.
Typically in the duodenal ulcer, epigastric pain appears during the fasting state, between one and three hours after meals or at night. It can also occur in relation to stress situations.
This epigastric pain is relieved by eating any kind of food or taking antacids pills in few minutes, and reappears cyclically again, within two hours. Symptoms may persist for several days, weeks or months.Two- third of patients with duodenal ulcer refer that the pain wakes them at night, being uncommon to have pain upon waking in the morning. There is infrequent presence of anorexia and/or weight loss in these patients. By contrary, most of them often manifest hyperphagia and weight gain, probably because the pain usually subsides with ingestion of food. This is the well known three steps - sequence of “pain/ingestion of food/alleviation” [14].
Several complications can occur in patients with peptic ulcer disease of any etiology. They are the main reasons for the high morbidity and mortality associated with this disease found until now.
The routine application of different gastroprotection strategies and eradication therapies for Helicobacter pylori infection, have reduced significantly the incidence relative to that seen in the previous decades. They are more common in habitual smokers and chronic NSAIDs users [16,17]. There are four major complications of peptic ulcer disease: Bleeding, perforation, penetration and obstruction.
Although its incidence has declined a little in the recent years; however remains being the most common complication and appears in around 10-20% of patients. It is a frequent cause of admission in emergencies.
Ulcers related with NSAIDs are more likely to bleed than those caused only by H. pylori chronic infection. Populations at a greatest risk are the elderly and those with other serious conditions, such as respiratory, cardiac, cerebrovascular o renal problems [18].
A total of 80-90% of upper gastrointestinal hemorrhage are not from variceal bleeding origin , and around 40-50% of these are caused by peptic ulcer disease. The mean associated mortality is around 5.5% [19].
It is an uncommon complication, which represents approximately 5% of ulcer-related complications. Until about 1970, peptic ulcers represented the most common cause of obstruction to gastric emptying [25]. In the last years, however, has decreased the frequency of obstruction secondary to peptic ulcer and currently gastric malignancies are the leading cause of gastric outlet obstruction [26].
It is mandatory to perform a good clinical history and a complete physical examination, in order to make a complete data collection of all the symptoms and signs of PUD. Also, it is extremely important to register all the past medical antecedents, and the duration of alcohol intake, history of NSAIDs and smoking consumption, and also for the posible existence of previous episodes of peptic ulcer.
The signs suggesting benign origin are the presence of regular mucosal folds surrounding the ulcer base and the fibrin deposit at the crater base (Figure 1). The features that suggests malignancy, are the finding of overhanging margins, irregular or thickened borders and/or the presence of an ulcerated mass, that protrudes into the lumen (Figure 2).
Malignancy of the duodenal ulcers is exceptional. Therefore, it is rutinary biopsy is not recommended. However, it is mandatory to take several mucosal biopsies form the margins at any gastric ulcer, despite it is benign appearance. A follow-up endoscopy will be performed until the healing is completed [27].
Diagnostic tests for H. pylori are divided into direct (based upon the need for endoscopy) and indirect tests, and several tests are used not only for diagnosis, but also in the follow-up after the eradication treatment in order to confirm this one (Table 2 and 3) [28].
General care
It is essential to avoid potential contributing agents such as NSAIDs or tobacco. There are no firm recommendations on alcohol intake or dietary habits, apart from not eating foods that can aggravate the symptoms [29].
Helicobacter pylori-negative
The main etiology is related to the use of NSAIDs, so withdrawing these treatments is a crucial step. In H. pylorinegative, NSAID-negative ulcers, a detailed search should be made to detect other contributing factors, such as medical comorbidities, poor nutritional status, ischemia and acid hyper-secretory disorders. The management of uninfected patients is based on the classic anti-secretory therapy [29,30].
PPIs are most effective when taken 30-60 minutes before meals. Global ulcer healing rates are above 75%, although PPIs achieve better results than H2RAs (near 100%). Therefore, the use of PPIs is recommended whenever possible. If a standard PPI therapy fails to heal a peptic ulcer, it is recommended to try twice daily dosing or switch to another PPI. For large ulcers (>2-3 cm), double dose of PPI is recommended for 12 weeks. Higher doses are necessary to control symptoms in other hypersecretory states, such as the Zollinger-Ellison syndrome.
The H2RAs and PPIs are usually well tolerated with a low incidence (< 3>
In this regard, it has been described that pantoprazole has the lowest potential for P450 metabolism and drug interactions [32]. In view of the inconclusive data, PPIs with weaker inhibition power of CYP2C19, are preferred in combination with clopidogrel, compared with those with stronger inhibition such as omeprazole [33].
H. pylori infection in NSAIDs users: H. Pylori infection is associated with an increased risk of the development of gastroduodenal ulcers and its complications in NSAIDs and low-dose aspirin users [34]. The available data helps in H. pylori eradication before starting NSAIDs treatment. It is also appropriate to test and treat this infection, following the presentation of any clinical ulcer. If NSAIDs or aspirin are continued, treatment of such patients with a PPI in addition to the eradication therapy, can reduce the risk of recurrent ulcer complications.
Refractory ulcers: Peptic ulcers that have not healed after proper treatment for 12 weeks are considered as refractory lesions [29]. In this context, the following conditions must be investigated: Persistence of H. pylori infection or false negative in the initial diagnosis, hidden NSAIDs use, non-compliance of prescribed treatment, giant or fibrotic ulcers, ulcerated tumors, tobacco consumption and acid hypersecretory states. Chronic ischemia caused by the narrowing of celiac artery may also be considered, in this situation. In the absence of all these risk factors, it is recommended to insist on all medical options before indicating surgery.
Pregnancy and lactation: Omeprazole is listed by the FDA as a pregnancy class C medication, whereas all other currently available PPIs, and H2RAs such as cimetidine and ranitidine, are class B. Although the results in some analysis of prospective data have shown that the global risk is low in pregnancy with potential toxicity during lactation, the lack of data in humans, precludes to achieve definitive conclusions regarding their safety [35]. Currently, there are no guidelines to treat H. pylori infection during pregnancy. It has been suggested that eradication should be deferred after delivery and lactation [36].
Treatment choices include standard triple therapy, sequential therapy, quadruple therapy, and levofloxacin-based triple therapy. Standard triple therapy is only recommended when resistance to clarithromycin is low. Chronic use of NSAIDs in patients with H. pylori infection increases the risk of PUD.
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.
