AUCTORES
Globalize your Research
Chat with us
Case Report | DOI: https://doi.org/10.31579/2692-9422/076
Department of Radiology, Le Bonheur Hospital, The University of Tennessee Health Science Center, Memphis, Tennessee, USA.
*Corresponding Author: Som Biswas, Department of Radiology, Le Bonheur Hospital, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
Citation: Som Biswas, (2023), Pulmonary Thromboembolism in Covid-19 Pneumonia: A Case Series and Update, J. Brain and Neurological Disorders. 6(6): DOI:10.31579/2692-9422/076
Copyright: © 2023, Som Biswas. 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: 07 August 2023 | Accepted: 21 August 2023 | Published: 30 August 2023
Keywords: covid-19; pulmonary thromboembolism; pneumonia; ct angiograph
Background: COVID-19 is associated with lots of complications. Pulmonary thromboembolism is a rare complication of pneumonia that is showing a rising trend in the context of COVID-19.
Case presentation: We present the CTPA findings in 3 patients of pulmonary thromboembolism in patients with COVID-19 pneumonia. The patients had varying involvement of pulmonary arteries. We also provide and update on the published literature on covid pulmonary embolism in 2023.
Conclusions: Pulmonary embolism can complicate Covid-19 pneumonia and lead to poorer prognosis. Hence, the correct diagnosis is imperative as prompt antithrombotic therapy can significantly reduce mortality and morbidity. There have been updates on pulmonary embolism in Covid-19 patients especially in late 2022 to early 2023 and they have been presented in this study.
COVID-19 pneumonia is known to be caused by the SARS-CoV-2 virus [1]. This global pandemic reached every part of the world since the detection of the first human case in the December 2019 [2,3]. Covid-19 causes primarily respiratory symptoms that can be mild to severe [4]. Severe Covid-19 pneumonia can cause pulmonary thromboembolism [5]. As countries like China are seeing new covid waves in December 2022 [6] it is likely that there will be an increase in cases of Covid pneumonia with pulmonary thromboembolism too.
Pulmonary embolism (PE) is a serious complication that can occur in patients with COVID-19. The occurs when a thrombus forms in the deep veins, mostly in the legs, and then travels to the lungs, where it can block blood flow and cause serious damage. PE is a well-known complication of COVID-19, and the risk of developing the condition is increased in patients with the virus. This is because COVID-19 can cause blood clots to form more easily, and the virus can also lead to inflammation in the lungs and other organs, which can make it harder for blood to flow properly. The features of pulmonary embolism include tachycardia, tachypnea, and dypnea. In some cases, patients may also experience coughing, fever, and sweating. These symptoms may be similar to those of COVID-19, making it difficult to diagnose PE. Diagnosis of PE is typically made through imaging studies such as pulmonary angiography or ventilation/perfusion (V/Q) scanning. Treatment of PE includes anticoagulant therapy, thrombolytic therapy, or a vena cava filter. It should be noted that patients with COVID-19 who have underlying conditions such as obesity, diabetes, hypertension, and cardiac disease, are at a high risk of developing PE. It's important to stay vigilant for clinical symptoms and signs of PE in COVID-19 patients, especially those with underlying conditions. Patients with mild pneumonia undergo chest radiographs and non-contrast chest CT. Patient with severe pneumonia or breathlessness out of proportion to lung involvement undergo CT Pulmonary Angiography for suspicion of pulmonary embolism.
We present imaging findings of 3 cases of covid-19 pneumonia who developed pulmonary embolism. Computed Tomography pulmonary angiography (CTPA) was done on these cases using Isovue 370 iodinated contrast. The amount of contrast used in CT pulmonary angiography (CTPA) varied depending on the patient's body weight.
Case 1
A 68-years old male presented having breathing difficulties with fever for 3 days. His respiratory rate was high at 42 breaths per minute, and he had a low blood pressure of 76 mmHg. He was given oxygen through a non-rebreather mask and received fluids and high-flow nasal cannula to stabilize his condition. Laboratory tests revealed an elevated WBC count, high levels of lactate, creatinine, and CRP, as well as abnormal D-dimer and fibrinogen. RTPCR from nasal swab was positive for COVID-19. D-Dimer was elevated. CTPA revealed small filling defect just distal to bifurcation of right pulmonary artery indicating small thrombus
Figure.1: The patient was given a dose of tissue plasminogen activator (tPA) which led to a rapid improvement in his condition. He was given heparin and apixaban for anticoagulation treatment and was discharged from the hospital after a week with improvement confirmed during follow-up telehealth visits.
Case 2:
A 55-years old female having no major past medical issues was admitted to the ICU with severe respiratory distress. She had been experiencing symptoms such as fever, shortness of breath, muscle pain, loss of smell and taste for 12 days, and was positive for COVID-19 through a nasal PCR test 8 days ago. At the time of admission, her temperature was high at 102.4F, heart rate was at 114 beats/minute, she was breathing rapidly at 39 breaths per minute, and had low oxygen saturation levels at 81% on room air. Laboratory tests showed an elevated WBC count with low lymphocyte count, mild liver inflammation, increased creatinine levels, high ferritin, lactate dehydrogenase, C-reactive protein, creatine kinase, D-dimer, procalcitonin, troponin, and BNP levels. She was admitted to the ICU. She was started on tocilizumab, hydroxychloroquine, antibiotics, proning, and received enoxaparin prophylactically. Being taken off the ventilator on the 9th day, she had another episode of hypoxia requiring high flow nasal cannula oxygen. On CTPA, filling defects were seen at bifurcation of right and left pulmonary arteries extending into proximal part of all the lobar arteries (Fig.2). Patchy flow is seen in distal lobar and segmental branches. Findings indicated bilateral pulmonary partial thrombosis. Interstitial thickening and GGOs were seen in all lobes of both lungs (Figure 2).
Figure 2: Axial CTPA showed filling defects at bifurcation of right and left pulmonary arteries extending into proximal part of all the lobar arteries (red arrow). Patchy flow is seen in distal lobar and segmental branches. Findings indicated bilateral pulmonary partial thrombosis. Interstitial thickening and GGOs were seen in all lobes of both lungs in axial lung window (black arrow).
She was administered anticoagulation therapy (heparin followed by apixaban) and improved and shifted from the ICU in the following week.
Case 3:
A 44-years old man presented with dyspnea for 4 days and was admitted
into the hospital with low oxygen levels. At the time of admission, his heart rate was 112 beats/minute, and oxygen saturation levels were low at 83% on room air. Laboratory tests showed elevated WBC count, high levels of BNP, troponin, CRP, lactate dehydrogenase, D-dimer, ferritin and procalcitonin. RTPCR from nasopharyngeal swab was positive for COVID-19. D-Dimer was elevated. CTPA demonstrated filling defect at bifurcation of right pulmonary artery and extends into its right descending branches indicating pulmonary thrombosis (Figure 3).
Figure 3: Axial CTPA demonstrated filling defect at bifurcation of right pulmonary artery and extending into its right descending branches indicating pulmonary thrombosis (red arrow). GGOs were seen in all lobes of both lungs in axial lung window (black arrow).
GGOs were seen in all lobes of both lungs (Figure.3). The patient underwent a successful mechanical thrombectomy using FlowTriever, which improved his oxygenation. Nasopharyngeal PCR test returned positive for COVID-19. He was administered antibiotics, hydroxychloroquine, and anticoagulation. Despite these treatments, his condition deteriorated with worsening lung inflammation. The patient finally succumbed to COVID-19 infection and pulmonary thromboembolism.
Relationship between pulmonary embolism and disease severity.
Yassin and colleagues [7] studied the connection between the occurrence of pulmonary embolism (PE) and the severity of COVID-19, as determined by lab results or CT scan scores. They included 96 patients with COVID-19 who were suspected of having PE and found that 40 of them tested positive, making up 41.7% of the patients. The study found that features such as worsening tachypnea, reduced oxygen levels, dyspnea, and coughing up blood were statistically significant indicators of PE, however, no significant difference was noticed regarding age or gender and the incidence of PE. The study also looked at the relationship between lab markers such as D-dimer, ferritin, CRP, white blood cell count, neutrophils, and lymphocytes and the incidence of PE, but found no significant correlation. However, subjects with positive PE had higher CRP and D-dimer compared to those having negative PE. Additionally, the study found that the progression of the disease was highly significant with the incidence of PE, suggesting that close monitoring of critically ill patients is crucial for early diagnosis and treatment.
Franco-Moreno et al [8] looked at the relationship between PE and the severity of COVID-19. Their study found that there were differences between PE characteristics in COVID and patients without COVID-19. COVID-19 patients did not have the classical risk factors for PE and had more markers of systemic inflammation. Radiologically, COVID-19 patients had a distal thrombi location and a lesser incidence of deep vein thrombosis. The study also found that mortality in hospitals was lower in COVID-19 patients, largely due to a higher prevalence of end-stage cancer causing death in non-COVID-19 subjects. The study also demonstrated that the risk of recurrent venous thromboembolism (VTE) in patients with COVID-19 was less, suggesting that stopping anticoagulant therapy after three months may be appropriate. Additionally, the incidence of chronic thromboembolic pulmonary hypertension (CTEPH) was lower in COVID-19 patients due to the distal topography of pulmonary embolism.
COVID-19 and Pulmonary Embolism Outcomes among Hospitalized Patients.
Nasrullah A at al [9] study is the largest one assessing the outcomes of patients with COVID-19 with and without PE. It consists of 1.6 million patients having COVID-19 pneumonia that were hospitalized. The study found that COVID-19 patients with PE had increased mortality in-hospital, cardiogenic shock, and need for mechanical circulatory support in comparison to those without PE. They also required a higher amount of vasopressors and ventilation and had a longer hospital stay and higher hospitalization costs Male sex and old age were found to cause a higher rate of mortality in both COVID-19 patients with or without PE, however, there was no relation of mortality with income, insurance, or race. The study also found that the rate of PE in patients with COVID-19 was 2.8%, which is less than reported in previous literature. The study notes that the difference in mortality could be explained by many factors including selection bias, sample size, and different virus strains.
Risk of thromboembolic events in non-hospitalized COVID-19 patients.
The study by Massoud and colleagues indicates that COVID-19 increases the chances of DVT in non-hospitalized patients. Furthermore, the study suggests that patients with COVID-19 who are not hospitalized have a significant risk of pulmonary embolism in comparison to the control group without covid, even at mild or assymptomatic infection levels. COVID-19 increases the chances of myocardial infarction (MI) in non-hospitalized patients. The chances of MI and stroke is significant in the first 7 days of COVID-19 infection, however, drop to insignificance within two weeks following the infection. This could be due to the pro-thrombotic and pro-inflammatory condition in the acute phase, leading patients to thromboembolism during both the infection phase and recovery phases. Factors such as vascular inflammation, hypoxia and endothelial dysfunction may also contribute to this increased risk.
Prediction of pulmonary embolism in patients with SARS-CoV-2 infection.
Franco-Moreno et al [11] found a high incidence of PE among patients with COVID-19, with 25.54% of patients in their study diagnosed with PE. This is consistent with other studies on critically or severely ill patients, but higher than the general population. All subjects in the study were on anticoagulation, raising questions about the development of PE despite prophylaxis. Factors independently associated with PE were found to be tachypnea and the absence of infiltrates on chest radiographs and increased D-dimer levels. However, the study found no clear risk factors for PE among patients with COVID-19 and no effective tools to predict PE in emergency department patients.
Prognostic association between d-dimer thresholds and 30-day pulmonary embolism diagnosis among emergency department patients with suspected SARS-CoV-2 infection.
In a study published in 2023 by Lin et al [12] of 10,837 patients, 3.7% of subjects were found to have PE at 30 days. A D-Dimer threshold of 500 ng/mL had a sensitivity of 97.8% and a specificity of 40.9%. An age-adjusted D-dimer threshold had a sensitivity of 96.0% and a specificity of 48.5%. D-dimer testing was less accurate for predicting Pulmonary embolism (PE) in patients who were positive for Covid-19 infection. Overall, the standard and age-adjusted D-dimer thresholds were similarly effective for predicting PE in the emergency department (ED) patients with suspected covid-19 infection as in non-covid ED patients.
Assessment of pulmonary embolism related to active SARS-CoV-2 infection in pregnant women.
Moreno-Ballesteros et al [13] found that pregnant patients must be anticoagulated at the minimum suspicion of PE. As they have a greater risk of bleeding and the need for its monitoring, so it is crucial to rule out early the presence of thrombotic phenomena. Although in the pregnant patient diagnosed with PE the D-dimer value was practically double that of the rest, this value continues to be a highly variable parameter and unspecific. Also, the effect of PE also turns out to be more serious for the fetus as it causes fetal distress due to low oxygenation. One patient had to undergo a cesarean section due to fetal distress following PE. Additionally, it should be noted that this patient presented a peripheral distribution subsegmental pattern of perfusion defects on scintigraphy, as described by other authors in patients diagnosed with PTE during COVID19 infection. Considering the non-specific nature of the clinical features and the D-dimer values in the COVID-19 context in pregnancy, perfusion scintigraphy lung plays a fundamental role in the diagnosis of PE, due to its higher sensitivity and lower radiation than CT.
The cases presented above highlight the different ways in which COVID-19 and PE can present. Studies have shown that COVID-19 patients have an unusually higher risk of thromboembolism [14]. Research has also found a connection between the severity of COVID-19 and clot turnover, with patients who have higher levels of markers having a poorer prognosis. Additionally, studies suggest that for patients with severe COVID-19 disease, prophylactic anticoagulation may reduce mortality. The exact mechanisms behind the clotting problems related to COVID-19 are not fully understood, but it is believed that the virus infects vascular endothelial cells, causing damage and platelet activation. It is unclear to what extent COVID-19 increases the chances of thrombosis compared to other causes. In conclusion, it is important to maintain a high suspicion for thromboembolic disease in patients with COVID-19, especially those with unexplained hypoxemia, critical illness, or rapid deterioration. More research is required to understand the importance of empiric or preemptive therapeutic anticoagulation in treating COVID-19 patients
Ethics approval and consent to participate
‘Not Applicable’.
‘Not Applicable’.
Availability of data and material
Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.
Competing interests
"The authors declare that they have no competing interests".
Funding
“No funding was obtained for this study”.
Authors' contributions
"SSB analyzed and interpreted the data. SSB was a major contributor in writing the manuscript. All authors read and approved the final manuscript."
‘Not Applicable’.
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
