AUCTORES
Globalize your Research
Research | DOI: https://doi.org/10.31579/2693-4779/065
Naschitz, Bait Balev Nesher and the Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
*Corresponding Author: Jochanan E. Naschitz, Bait Balev Nesher and the Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
Citation: Jochanan E. Naschitz, N Zaigraykin, E Zlotover, F Neime. (2021) Vitamin K deficiency under enteral feeding: real or imagined threat. Clinical Research and Clinical Trials. 4(4); DOI: 10.31579/2693-4779/065
Copyright: © 2021 Jochanan E. Naschitz, 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: 15 September 2021 | Accepted: 27 September 2021 | Published: 08 October 2021
Keywords: vitamin K; enteral nutrition; palliative care; prothrombin time; hemorrhage; bleeding
Patients receiving enteral feeding may develop vitamin K deficiency if the nutrition formula does not meet their daily vitamin K requirement. Vitamin K is essential for clotting factors II, VII, IX and X to be released in their functional form. Under vitamin K deficiency a coagulopathy may develop which is marked by prolongation of the prothrombin time (PT). There might be a need, unrecognized to-day, for monitoring the PT in patients receiving enteral feeding to unmask a latent coagulopathy. We assessed the prevalence of a prolonged PT in patients receiving enteral feeding for 3 months of more with one or a combination of the enteral formulas Osmolite®, Jevity®, Easymilk®. Twenty-three residents in long-term hospital care received solely enteral feeding for an average of 37 months, SD 21 months. The median daily vitamin K supplied by enteral feeding was 96.8 mcg (average 103.3 mcg, SD 28.8); this does not satisfy the 150 mcg of vitamin K required by the Food and Drug Administration. In 21 patients the PT-INR was 1-1.2 (normal). The PT was prolonged in two patients. In one of the latter, prolongation of PT-INR was not confirmed two days later. In the second case, the patient having repeatedly a PT-INR 1.4 (and a normal APTT), administration of vitamin K did not correct the PT. In conclusion, long-term vitamin K-deficient nutrition did not affect the vitamin K-dependent coagulation. This data may argue against the supposed need to monitor the PT in patients receiving long-term enteral nutrition.
Does vitamin K deficiency evolve under prolonged enteral feeding? This question was raised during a challenging clinical encounter. A 63-year-old man admitted to hospital with an ischemic stroke was diagnosed with a left ventricular mural thrombus. Enoxaparin treatment was started. Over 6 weeks there were two episodes of major hemorrhage needing brief discontinuation of anticoagulation. During this hospitalization a previously normal prothrombin time, PT-INR 1.02, became lengthened to 2.5. Intravenous administration of 10 mg vitamin K provided within 2 days normalization to PT-INR 1.1, upon which vitamin K deficiency was diagnosed [1]. Vitamin K deficiency in the patient was ascribed to enteral feeding with Osmolite® a formula which does not contain the daily requirement of vitamin K [2]. The patient was not receiving any medication known to interfere with vitamin K-dependent gamma-carboxylation of glutamic acid [3, 4] which may modify the PT.
Scrutiny of the literature provided no conclusive answers to the questions a) whether there is need for monitoring the PT in patients receiving enteral feeding, b) more so in patients receiving enteral feeding along with low molecular weight heparin or a direct oral anticoagulant, c) is there a need to fortify feeding formulas with vitamin K? [2, 5, 6]. We designed the present study in an attempt to address these issues.
Within the framework of a retrospective observational study approved by the Institutional Review Board data of routine coagulation tests were reviewed. Included in the study were 23 three residents of a department designed for long-term mechanical ventilation, those who were receiving enteral feeding for three months or longer. Excluded were residents eating by mouth, those who were supplementing enteral feeding with oral meals, and residents having had a bleeding event during a 28-day period before the coagulation tests were taken. Demographical and clinical patient data were searched in the electronic data base: age, gender, length of stay in the ward, length of enteral feeding, brand of enteral formula, content of vitamin K in the enteral formula, minor and major bleeding events, coagulopathy, bariatric surgery, chronic diarrhea, arterial hypertension, ischemic heart disease, congestive heart failure, diabetes mellitus, COPD, cancer, liver disease, antiphospholipid antibody syndrome, systemic lupus erythematosus, tracheostomy, mechanical ventilation, use of anticoagulant medication. The following enteral feeding formulas were in use: Osmolite HT® (Abbott nutrition, USA) which contains 61 mcg/L vitamin K, Jevity® (Abbott nutrition, USA) containing 61 mcg/L vitamin K, Easymeal-k2® (Easyline, Israel) containing 110 mcg/L vitamin K. The vitamin K supplied daily by enteral feeding was calculated and referred to the FDA recommended dose [2].
The PT-INR and APTT were assessed according to the standard method [7] with PT-INR in the range 1 to 1.2 is accepted as normal. When the PT-INR was >1.2 and confirmed on a second examination, the patient's data were reviewed for possible cause of hypoprothrombinemia: liver disease, chronic bleeding disorder, malabsorption, diet low in vitamin K, disseminated intravascular coagulation, medications interfering with vitamin K activity. If neither was detected, a single dose of 10 mg vitamin K1 was administered by feeding tube and the PT-INR was reassessed 72 hours later. If the PT-INR was not corrected the procedure was repeated. The prevalence of a prolonged PT-INR (>1.2) correctable by administration of vitamin K was assessed and related to the patients’ clinical background and daily vitamin K supplied.
Twenty-three patients constitute the study cohort (Table 1).
There were 13 women and 10 men, median age 68 years, all having failed to be weaned from mechanical ventilation. Enteral feeding was supplied by gastrostomy. The diagnoses, more than two in each patient, were: unaware wakefulness state in 16 patients (following anoxic brain damage or traumatic brain injury), cerebrovascular accident 7, neurodegenerative disorder 5, diabetes mellitus 8, arterial hypertension 12, ischemic heart disease 6, chronic obstructive lung disease 2, chronic liver disease 5 (in all cases asymptomatic), rheumatoid arthritis 1, cancer in 1 patient. The median length of hospitalization in our ward was 36 months. Bleeding events during hospitalization in our ward were minor bleeding events (BARC type 2) witnessed in 9 patients (epistaxis, mild hemoptysis, colostomy related maceration of the skin) and major gastrointestinal hemorrhage (BARC type 3a) in one patient [8].
Enteral feeding consisted of one or a combination of the following: Jevity in 17 patients, Osmolite HT in 8 patients, and Easymeal in 6 patients. The median daily vitamin K supplied by enteral feeding was 96.8 mcg (average 103.3 mcg, SD 28.8), that is less than the FDA recommended minimum of daily 150 mcg [2]. There were two exceptions, one patient received 169 mcg vitamin K/day and another 176 mcg vitamin K/day.
In 21 patients the PT-INR was 1 - 1.2 (normal); it was prolonged in two patients. In one of the latter, prolongation of the PT-INR was not confirmed on duplicating the test 3 days later without having supplemented vitamin K. In the other case, the patient having repeatedly PT-INR 1.4 and normal APTT, administration of vitamin K did not correct the PT; this patient had no features of systemic lupus erythematosus, other rheumatic disorders, or malabsorption. He was not receiving any medication known to cause hypoprothrombinemia [3,4]. A prolonged PT which was not correctable by administration of vitamin K could not be attributed to vitamin K deficiency. The patient’s general condition did not allow for a detailed work-up of other possible causes of prolonged PT.
In the patients of this study there was no correlation between the daily total vitamin K supplied by enteral feeding and occurrence of bleedings (Figure 1).
Vitamin K is obtained from green vegetables contained in the food and by bacterial synthesis in the gut. Vitamin K deficiency arises when the vitamin K content in the diet is persistently low or when the absorption of vitamin K is defective. The latter occurs in obstructive jaundice where bile cannot reach the duodenum [9], as well as after bariatric surgery [10]. Patients receiving enteral nutrition or total parenteral nutrition if it is not adequately fortified with vitamin K may develop vitamin K deficiency [5]. The requirements of the Food and Drug Administration for an effective adult parenteral multivitamin drug product specify addition of 150 microg of vitamin K [2]. However, according to a dedicated study, none of 62 nutritionally complete enteral formulas contained the daily vitamin K requirements [3]. Neither did the enteral formulas the patients were receiving in our study.
The PT is a single-stage coagulation screening test for extrinsic and common pathways. An abnormally long PT is caused either by low plasma levels of one or several of coagulation factors II, V, VII, X and fibrinogen, or by inhibitors against these factors [7]. Vitamin K is essential for the posttranslational gammacarboxylation of clotting factors II, VII, IX and X (and the natural anticoagulants protein C and protein S); in the absence of vitamin K these factors are released from the liver in a non-functional form. As a result, the PT is prolonged. On this basis the PT is used as an indicator of the vitamin K status. At present, the dietary recommendations for vitamin K intake are based on the dose required to prevent bleeding. Indeed, the importance of vitamin K for hemostasis is determined by the fact that vitamin K deficiency may cause life-threatening bleeding.
However, the physiological roles of vitamin K are numerous, widely beyond synthesis of coagulation factors. So, vitamin K carboxylates osteocalcin which is important in transporting calcium to bone. Vitamin K activates matrix Gla protein an inhibitor of vascular calcification. Vitamin K carboxylates Gas6 protein which is protective against cognitive decline and neurodegeneration. Vitamin K exerts antiproliferative, proapoptotic, autophagic effects and has been associated with a reduced risk of cancer [11, 12]. While conventional recommendations are based on the dose of vitamin K required for preventing bleeding, there is a call to provide higher doses of vitamin K for the benefit of several chronic conditions, especially among elderly people [11].
Vitamin K is poorly retained in the body. Studies with [3H]-labeled phylloquinone indicated that 60–70% of doses in the range of 45–1000 microgram of vitamin K1 were excreted within 5 days (6). Patients of the present study, by receiving enteral nutrition deficient in vitamin K and no other supplements of vitamin were most likely in a vitamin K deficient state. Yet their PT-INR did not signal a coagulopathy. The dissociation between a deficient bodily vitamin K status and the normal PT might be explained by the “triage theory” which states that during a poor dietary supply vitamins are preferentially utilized for functions which are essential for immediate survival (12); such is synthesis of coagulation proteins. Hence, the PT is not a sensitive indicator of the body's vitamin K status. Ideally, undercarboxylated prothrombin (Protein Induced by Vitamin K Absence/antagonism, PIVKA-II) is used as an accurate indicator of the hepatic vitamin K status [13, 14].
In our study the PT-INR correlated neither with the history of bleeding nor with the deficient vitamin K status assumed to exist. Accordingly, monitoring the PT-INR in patients receiving enteral nutrition does not appear to be practical for preventing bleeding. Rather, fortifying feeding formulas with higher doses of vitamin K might be useful in virtue of the numerous beneficial effects of this vitamin.
There are limitations to our study related to the small number of patients assessed, the study cross-sectional design, and unavailability of high-sensitivity vitamin K assays. The strength of the study consists in recruiting the most severe patients, long duration of enteral feeding, accurate and prolonged medical observation, and the confident assessment of vitamin K supplied.
Long-term vitamin K-deficient enteral nutrition did not affect the vitamin K-dependent coagulation. This data argues against the need monitoring the PT in patients receiving long-term enteral nutrition.
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.
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
