AUCTORES
Globalize your Research
Chat with us
Case Report | DOI: https://doi.org/10.31579/2690-1919/022
1 Department of Surgery, Rotherham Hospital, United Kingdom.
*Corresponding Author: Lava Krishna Kannappa, Head, Department of Surgery, Rotherham Hospital, United Kingdom.
Citation: Lava Krishna K, Sufian K, Noor Ul AA, Monisha C, Risa M, Yahya S, Dimitrios P, M Ilyas Khan, Musthaq S, Omar T Chitakattil O (2020) Superior Mesenteric Syndrome –Acute On Chronic Presentation and A Review. J Clinical Research and Reports, 2(5); DOI:10.31579/2690-1919/022
Copyright: © 2020 Lava Krishna K. 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: 23 January 2020 | Accepted: 07 February 2020 | Published: 13 February 2020
Keywords: superior mesenteric syndrome; chronic; treatment; ICU; TPN
A 24-year-old Caucasian male presented with low GCS, seizures, severe vomiting and hypokalaemia initially admitted under the physicians through the Emergency Department and later shifted to the Intensive care unit (ICU). The initial diagnosis was Acute Kidney injury with metabolic hypochloraemia and hypokalaemic alkalosis with a background of Chronic Kidney disease treated under the Nephrologist in the past. In ICU, Patient was intubated and resuscitated with intravenous fluid resuscitation and correction of electrolyte abnormalities. The patient also had aspiration pneumonia in ICU and was treated with intravenous antibiotics Total parental nutrition (TPN) for nutritional support and Pabrinex due to the risk of refeeding syndrome. The patient also developed swelling right arm and an Ultrasound of the right Arm showed right-sided jugular vein thrombosis and was treated with anticoagulants. He had a CT (Computer Tomography) scan of the head for low GCS, which did not reveal any abnormality, Lumbar puncture and CSF analysis were normal. CT scan of the abdomen and pelvis with contrast revealed a diagnosis of superior mesenteric artery syndrome. He responded well to conservative treatment in ICU and was discharged with a referral to a tertiary center for further management.
A 24-year-old Caucasian male presented with low GCS, seizures, severe vomiting and hypokalaemia initially admitted under the physicians through the Emergency Department and later shifted to the Intensive care unit (ICU). The initial diagnosis was Acute Kidney injury with metabolic hypochloraemia and hypokalaemic alkalosis with a background of Chronic Kidney disease treated under the Nephrologist in the past. In ICU, Patient was intubated and resuscitated with intravenous fluid resuscitation and correction of electrolyte abnormalities. The patient also had aspiration pneumonia in ICU and was treated with intravenous antibiotics Total parental nutrition (TPN) for nutritional support and Pabrinex due to the risk of refeeding syndrome. The patient also developed swelling right arm and an Ultrasound of the right Arm showed right-sided jugular vein thrombosis and was treated with anticoagulants. He had a CT (Computer Tomography) scan of the head for low GCS, which did not reveal any abnormality, Lumbar puncture and CSF analysis were normal. CT scan of the abdomen and pelvis with contrast revealed a diagnosis of superior mesenteric artery syndrome. He responded well to conservative treatment in ICU and was discharged with a referral to a tertiary center for further management.
Past history included multiple admissions over six years for vomiting and pyelonephritis. Oesophago-gastro duodenoscopy (OGD) showed gastric stasis with ulcers in the gastric antrum and duodenum. Barium meal showed a failure to progress beyond Duodenum and confirmed gastric outlet obstruction. He had lost about 2 stones over the last couple of years and was on proton pump inhibitors and Anti-emetics.
Radiological findings:
The images from the CT abdomen showed signs of SMA syndrome are as shown below.
Etiology and Pathophysiology aspect of the disease:
The SMA originates at the level of the third lumbar vertebrae and forms an angle as it takes an anterior and caudal course from its origin of abdominal aorta. The space between the aorta and SMA is occupied by fat and lymphatic tissue and the loss of these tissue following certain conditions leads to compression of the relatively fixed third part of the duodenum leading to SMA syndrome [3,4]. Studies have also reported SMA syndrome is also caused by a short Treitz's ligament and low origin of SMA which caused a decline in the angle formed by the aorta and the SMA [5].The mean angle formed between the SMA and aorta varied between 38˚,41.25˚ and 56˚ from studies in the literature4 .The range of angles varied between 20˚ to 70˚ [6-8] and the mean aorto‐mesenteric distance between 10–28 mm [9]. Patients affected by SMA syndrome have an angle of < 25>
Ahmed et al (1997) [5] categorized the etiology of SMA syndrome into factors that predispose and those precipitate the condition as depicted below in table 2:
Ahmed et al proposed, that humans due to the erect posture naturally have a downward angle of the origin of SMA from aorta which predisposes them to SMA syndrome, unlike the quadrupeds having a right angle origin. The study logically argued about duodenum suspended by the ligament of treitz (LOT) differs in the length between different individuals and people with short LOT are at higher risk of developing SMA syndrome due to duodenum moved higher into the narrow area of the aorto-mesenteric angle. The study mentions about the hypothetical possibility of a lower position of the duodenum does not offer any advantage due to the aorta being pushed forwards as the spine curves anteriorly at the level of L4 vertebrae which will reduce the distance between aorta and SMA [5].
An initial study by Hines et al (1984) [4] and review update by Welsh et al (2007) [10] used the word predisposing factors rather than dividing into predisposing and precipitating factors by Ahmed et al. In addition to the factors listed in table 2. The studies mentioned the following factors predisposing SMA syndrome. 1) Chronic wasting disease like cancer, cerebral palsy, Paraplegia, cardiac cachexia and drug abuse 2) Trauma due to injuries like burns, Brain injury and multiple trauma. 3) A dietary disorder like anorexia nervosa and malabsorption 4) Post-operative states after bariatric surgery, ileoanal pouch anastomosis, Nissens fundoplication, aortic aneurysm repair, scoliosis surgery 5) peritoneal adhesions, Neoplasia of mesenteric root and dissecting aortic aneurysms as possible causes [10].SMA has been reported in conditions like HIV and Methamphetamine abuse[11] in recent studies.
Clinical presentation and management:
The clinical symptoms can present acutely or chronic with gradual onset of symptoms depending on the grade of obstruction. The diagnosis can be easily confused with SMA-like syndrome due to decreased duodenal peristalsis in conditions like pancreatitis, diabetes, dermatomyositis, Lupus erythematous, Myxoedema, Amyloidosis and Myotonic dystrophy often procrastinating the diagnosis leading to deterioration in an already deprived nutritional status due to weight loss [5,12]. Patients presenting acutely have symptoms of duodenal obstruction like pain abdomen, vomiting, distension, abnormal bowel sounds with electrolyte abnormalities, which were aggravated by eating and relieved by adopting knee-chest and prone position as it is known to increase the angle between the aorta and SMA [13]. The subset of the population with chronic presentation shows the persistence of intermittent abdominal pain associated with anorexia and early satiety [5]. The patient above serves as an example of how the diagnosis is difficult and challenging and often doctors are misled. Having a high index of suspicion of SMA syndrome is always helpful in treating the patients optimally and even helps further if a surgical option is deemed necessary
Lee et al (2012) study of a large case series of 80 patients described the patients to be mostly females (53/80) with a median age of presentation at 28 years. The median body mass index at diagnosis was 17.4 kg/m2 , with a range of 10 to 22.1 kg/m2 . About 50 % of the patients in the study were associated with mental and behavioral disorders (21.3%), infectious disorders (12.5%) and disorders of the nervous system (11.3 %). The symptoms noted were vomiting (70%), Nausea (66.3%), Abdominal pain (65%), Anorexia (33.8%), and Postprandial fullness (33.8%) [14].
Biank et al (2006) case series of twenty-two pediatric patients found a majority of patients were female (64%) with presenting symptoms of abdominal pain (59%), vomiting (50%), nausea (40%), early satiety (32%) and anorexia (18%). SMA syndrome in children most often present acutely rather than chronic with no weight loss as a predisposing factor and medical management being more successful [15].
The investigations available for diagnosis include X-ray, Barium swallow, Ultrasound Doppler, Computer tomography (CT), Magnetic resonance imaging (MRI) angiography and Endoscopy for diagnosis. Plain X-ray might show normal or dilated stomach with diminished bowel gas findings [16]. Ultrasound Doppler can be used to measure the mesenteric angle after overnight fasting during normal expiration at about 2 cms below the origin of the SMA in right lateral, standing and supine position and proved to be effective tool and could be used in epidemiological screening to diagnose suspected cases of SMA syndrome [9]. But, Ultrasound can be operator dependent and might not be suitable to be done as emergency settings.
Barium swallow might show proximal duodenum dilatation, but also the classic abrupt termination of the swallow in the third part of the duodenum with obstruction, which is relieved when the patient takes a left lateral decubitus position [4].Radiologic criteria for the diagnosis of SMA syndrome comprises of 1) Dilatation of the first and second parts of the duodenum, with or without gastric dilatation, 2)Abrupt vertical and oblique compression of the mucosal folds, 3) Anti-peristaltic flow of contrast medium proximal to the obstruction, (iv) delay in transit of 4–6 h through the gastroduodenal region, and 4) relief of obstruction in a prone, knee-chest or left lateral decubitus position [4,17]. CT scan of the abdomen with contrast helps not only diagnosing SMA syndrome but also to exclude the differential diagnosis. CT scan can determine the aortomesenteric angle, distance, the grade of duodenal compression, the extent of the loss of adipose and lymphatic tissue at the AM angle, Aneurysms, dilatation of left renal vein, Neoplasia and lastly can be used for planning before surgery [10,18-20]. Endoscopy might reveal distended stomach and proximal duodenum and also rule out gastric or duodenal ulcer disease, intestinal intraluminal obstruction and conditions mimicking SMA syndrome [10].
Conservative management is the preferred line of management of patients with SMA syndrome and preferably involve a multi-disciplinary team approach of working closely with gastroenterologists, radiologist, Dieticians and surgeons with an objective of improving the nutritional status and weight gain, which in turn can increase the adipose tissue and increase the aorto-mesenteric angle for alleviation of symptoms. The conservative approach encompasses measures like Nasogastric tube insertion for decompression of the stomach and the duodenum, Feeding through nasojejunal tube or total parenteral nutrition (TPN), correction of electrolyte abnormalities, Appetite stimulations, Anti-emetics, prokinetic agents and postural therapy like left-lateral or prone position, when the patient is able to tolerate oral feeds which can relieve the symptoms if the patients have oral feeding [3,10,18,21]. The conservative approach has an estimated success rate of 85% and also works in patients with symptoms less than a month [15]. Patients who fail with the conservative approach are considered for surgery. Surgical options include Strong’s procedure (a division of the ligament of Treitz and positioning of the duodenum to the right side of SMA preventing compression) [22]. The procedure has fallen out of choice as the procedure aggravated the symptoms and technically difficult or impossible to mobilize duodenum due to adhesions and the interference of short vessels from the inferior pancreaticoduodenal artery [7,23]. Few studies have reported Gastrojejunostomy can be performed, if severe gastric distention is present with good results [24]. However, Lee et al (1978) study showed, in spite of having Gastrojejunostomy, which provided adequate decompression of the stomach. The procedure failed in relieving duodenal obstruction [25]. The standard practice presently followed is laparoscopic duodenojejunostomy with a success rate of 80-100% with added benefits of minimal blood loss, decreased post-operative pain, better cosmetic outcome, early recovery period, faster discharge rate [11,26,27].
SMA syndrome is one of the rare disease presenting with symptoms which are atypical, insidious in onset and pose a diagnostic dilemma unless the doctors have a high degree of suspicion in a population presenting with weight loss, Nonspecific abdominal pain and early satiety. Prompt recognition of symptoms with an early diagnosis with CT scan and involvement of a multidisciplinary team of Gastroenterologist, Radiologists, dieticians, and surgeons (General and vascular) should form the objective of improving the nutritional status and weight gain with the alleviation of symptoms. If a conservative approach does not work, then surgical options should be exercised.
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.
