AUCTORES
Globalize your Research
Research Article
*Corresponding Author: Clevio Desouza, Department Of Orthopaedics, Holy Spirit Hospital, Andheri, Mumbai.
Citation: Clevio desouza, yogesh khandalkar, maulik langaliya, shail shah. (2022). Efficacy Of Modified Vaccum Assisted Dressing In Wound Healing Of Open Injuries. Journal of Orthopedics and Surgical Sports Medicine. 5(2); DOI: 10.31579/2641-0427/32
Copyright: © 2022, clevio desouza. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, providedthe original work is properly cited.
Received: 14 February 2022 | Accepted: 28 February 2022 | Published: 16 March 2022
Keywords:
To assess the efficacy of modified vacuum assisted dressings as compared to conventional betadine wound dressings in improving the healing process in open injuries and to prove that modified vacuum assisted dressings can be used as a much better treatment option in the management of open injuries.
Material and Methods: This was prospective non-randomized comparative study where data from 60 patients with open injuries, of which 30 patients were included in each group. The results were compared based on average reduction of the wound size and average duration for formation of healthy granulation tissue. The variables were compared using Mann Whitney U test and independent t test, P value was <0.05 and was considered significant.
Results: Among 30 patients treated with modified vacuum assisted dressings the mean reduction in size of the wound overall is 15.06 mm and overall time for appearance of healthy granulation tissue is 7.7 days. 25 patients required flap as a definitive closure procedure whereas in 20 patients wound was closed by split skin grafting and 5 wounds was contracted with treatment on comparison with 30 patients treated with conventional betadine dressings the mean reduction in size of the wound overall is 7.7 mm and overall time for appearance of healthy granulation tissue is 18.8 days. 4 patients required flap as a definitive closure procedure whereas in 18 patients wound was closed by split skin grafting and 8 wounds was contracted with conventional betadine dressing’s treatment without requiring a secondary procedure. There is significant decrease in reduction in size of wound and average duration.
Vacuum-assisted closure (VAC) is a new technique in the challenging field of management of contaminated, acute, and chronic wounds. Vacuum assisted closure (also called vacuum therapy, vacuum sealing, or topical negative pressure therapy) is a sophisticated development of a standard surgical procedure and involves the use of vacuum to remove blood or serous fluid from a wound or operation site. Negative pressure wound therapy (NPWT) also called vacuum-assisted wound closure and refers to wound dressing systems that continuously or intermittently apply sub- atmospheric pressure to the surface of a wound. The application of controlled levels of negative pressure has been shown to accelerate debridement and promote healing in many different types of wounds. The optimum level of negative pressure appears to be around 125 mmHg below ambient, and it is believed that negative pressure assists with removal of interstitial fluid, decreasing localized edema and increasing blood flow. This in turn decreases tissue bacterial levels. Despite the significant costs involved, the technique is said to compare favorably in financial terms with conventional treatments in the management of difficult wounds [1].
The technique is very simple. It involves application of sterile, open-pore foam dressing directly on the wound. The wound is then sealed with an occlusive drape to create a closed, controlled environment. A fenestrated vacuum tube is connected to a vacuum source; fluid is drawn from the wound through the foam into a reservoir for subsequent disposal. Negative pressure is applied at 50-125 mm/Hg, resulting in a decrease in the local interstitial pressure, and effluent from the wound is drawn out into the collection device. Initially, the vacuum pressure is
Applied continuously. As the amount of drainage decreases, the vacuum may be subsequently being applied on an intermittent basis. The vacuum dressing is usually changed at 48-hour interval [2, 3].
Wound progress is recorded using parameters in the wound scoring system. The objectivity of assessments used to generate the wound score make this scoring system ideal for evaluating treatment and outcome of wounds. To evaluate efficacy of the modified method of vacuum dressing in wound healing in low resource settings.
Study Design: Prospective non-randomized study.
Study Size: 60 Cases.
Study Period: July 2018 to July 2020.
Patients were part of the study as per the inclusion and exclusion criteria.
Inclusion criteria:
Exclusion criteria:
Age and Sex Distribution:
Thirty patients who were treated with VAC therapy were between 8 years to 55 years. Among the thirty patients, twenty-five were male and five were female. Thirty patients who were treated with conventional betadine dressings were between 7 years to 66 years. Among the thirty patients, twenty-three were male and seven were female.
Assessment of Wound and Investigations done before starting VAC treatment:
Patients were evaluated with following investigations and wounds were assessed with following parameters-
Protocol before applying VAC:
Initially the wound is thoroughly debrided and all the devitalized tissue and foreign materials like mud etc. are removed and through wound wash is given. Antibiotics are given as soon as the patient is received in the emergency ward. Initially broad-spectrum antibiotics are given and later specific antibiotics are given according to sensitivity profile.
Protocol after each dressing:
The application of topical negative pressure moist dressings needs the following materials. They include
Application of VAC
\The topical negative pressure wound dressing is a combination of composite synthetic hydrocolloid sheet dressing with vacuum assisted wound closure systems. The technique involves six steps. These are
1. The wound is thoroughly debrided, and devitalized tissue removed. A perforated drain tube is placed on top of the wound bed and other end is brought out subcutaneously a little away from main wound [Figure 4].
2. The foam dressing is cut to size of the wound and applied over the drain tube [Figure 5].
3. The foam with the surrounding normal skin is covered with adhesive, semipermeable, transparent membrane. A good air seal must be ensured around the wound [Figure 6].
4. Distal end of the drain tube is now connected to a device which provides a negative pressure suction in the range of –25 to –200 mm of Hg. This can be achieved by wall suction apparatus, simple suction drain devices. Suction may be applied continuously or intermittently based on amount of wound discharge. Conventional VAC dressings use a computerized VAC device but, in our study, we modify the conventional technique by using cost - effective wall suction apparatus or a simple suction drain device [Figure 7].
5. Once vacuum is applied, the foam must be seen collapsed into the wound bed.
6.The fluid from the wound is absorbed by the foam and is removed from the wound bed by suction. The negative pressure must be maintained for an average of 10-14 days for maximum benefit as studies have proved. Once adequate granulation tissue is formed the dressing should be removed and definitive wound closure is achieved by partial or full thickness grafts, flaps, or suturing.
Data was analyzed using SPSS 22 version software. Mann Whitney U test was used as test of significance for qualitative data. Continuous data was represented as mean and standard deviation. Independent t test was used as test of significance to identify the mean difference between two quantitative variables, respectively. p value (Probability that the result is true) of <0>
The 60 patients admitted for the study were divided into two equal and comparable groups. Patients subjected to topical vacuum assisted dressings were classified under Group I and those who underwent conventional betadine dressings were classified as Group II. The patient’s characteristics of the two groups were well matched as given in the tables below.
The age wise distribution of the patients in this study was that the mean age of the group I was 31.37 years, the age group 20- 40 dominated the series accounting for 73% among the cases. Mean age of the group II was 34.20 years, the age group 20-40 dominated the series accounting for 67% among the cases.
Our study includes 30 patients treated with modified VAC therapy of which 25 patients were males (83%) and 5 female patients (17%), 30 patients were treated with conventional betadine dressings of which 23 patients were males (77%) and 7 female patients (23%).
Our study includes 30 patients treated with modified VAC therapy of which 13 patients were smokers (43%) and 17 nonsmoker’s patients (57%), 30 patients treated with conventional betadine dressings of which 11 patients were smokers (63%) and 19 nonsmokers patients (37%).
Our study includes 30 patients treated with modified VAC therapy of which 10 patients were diabetic (33%) and 20 nondiabetic patients (67%), 30 patients treated with conventional betadine dressings of which 7 patients were diabetic (23%) and 23 non diabetic patients (77%).
The mode of injury wise distribution of the patients in our study was that RTA (Road traffic accidents) dominated the series accounting for 90% among the cases in Group I and for 87% the cases among Group II. In 30 patients, location of open injuries was 56% in leg, 27 % in foot and 17% of wounds were with forearm treated with VAC dressings. In 30 patients, location of open injuries was 64% in leg, 23% in foot and 13% of wounds were with forearm treated with conventional betadine dressings.
5 patients required flap as a definitive closure procedure whereas in 21 patients wound was closed by split skin grafting. 4 wounds were contracted with VAC treatment without requiring a secondary procedure. 4 patients required flap as a definitive closure procedure whereas in 18 patients wound was closed by split skin grafting. 8 wounds were contracted with conventional betadine dressings treatment without requiring a secondary procedure.
Our study shows for 50% among the cases in Group I and for 53 % the cases among Group II were infected.
Distribution of cases based on Initial wound score:
Open wound score (Journal of Orthopedic surgery and research 2009 4:14)
Score 0: Skin and soft tissue intact
Score 1: Defect in the skin is present
Score 2: One of the following in the wound bed, a-Bone, b- Tendon, or c-implant
Score 3: A combination of any two of the above are exposed.
Score 4: Presence of deep infection
Distribution of cases based on Reduction in size of wound
Our study shows Patients with initial wound score 2 showed average reduction of 15.25 mm with and patients with initial wound score 3 showed average reduction of 15.66 mm and patients with initial wound score 4 showed average reduction of 13.25 mm at the end of VAC treatment. The mean reduction in size of the wound overall is 15.06mm on comparison with patients with initial wound score 2 showed average reduction of 7.95 mm with and patients with initial wound score 3 showed average reduction of 7.2 mm and patients with initial wound score 4 showed average reduction of 6.66 mm at the end of conventional betadine dressings treatment. The mean reduction in size of the wound overall is 7.7mm.
Distribution of cases based on average time for formation of healthy granulation tissue:
Our study shows Patients with initial wound score 2 showed time taken for appearance of healthy granulation tissue by average of 9.5 days and patients with initial wound score 3 showed time taken for appearance of healthy granulation tissue by average of 10.83 days and patients with initial wound score 4 showed time taken for appearance of healthy granulation tissue by average of 10 days and at the end of VAC treatment with appearance of healthy granulation tissue by mean 9.83 days on comparison with Patients with initial wound score 2 showed time taken for appearance of healthy granulation tissue by average of 18.6 days and patients with initial wound score 3 showed time taken for appearance of healthy granulation tissue by average of 19.4 days and patients with initial wound score 4 showed time taken for appearance of healthy granulation tissue by average of 19.6 days and at the end of conventional betadine dressings treatment with appearance of healthy granulation tissue by mean days.
The use of negative pressure wound therapy in the form of vacuum-assisted closure has been established as a promising method in the field of wound healing in a variety of wounds including those that are difficult to heal [4,5]. There are two main factors considered to be responsible for the dramatic response seen in these wounds: removal of fluid and mechanical deformation [6]. Removal of fluid decreases edema which decreases
the interstitial pressure resulting in increased blood flow. Mechanical deformation causes a wide variety of molecular responses, including changes in ion concentration, permeability of cell membrane, release of second messengers, and stimulation of molecular pathways increasing the mitotic rate of stretched cells.
Recently, Scherer et al. have concluded that vascular response is related to the polyurethane foam, whereas tissue strain induced by vacuum assisted closure device stimulated cell proliferation [7].
Duration for change of Dressing:
DeFranzo et al. advocated the changing at 2 days interval, while Banwell et al. recommend 4-5 days [8,9]. Singh SH et al. advocated change at 3-5 days interval. In our study, VAC dressing was changed every 3 days.
Rate of Infection:
Stannard et al, studied the impact of NPWT on severely contaminated open fractures and observed significant difference between the 16 groups for total infections [10]. With regular saline dressing, Henley et al, [11] reported 34.7% of infection. Charalambous et al, [12] reported 27% and, Gopal et al [13] reported 27.4% of infection. Comparatively our study showed overall 12.5% of infection.
Time for healthy granulation tissue formation and final reduction in wound size:
Our study showed a mean reduction in size of the wound by 15.06 mm after VAC therapy. Study by Kushagra Sinha et al. [14] showed a decrease in size of 1 to 4.9mm in 26.66% of patients in VAC group whereas 93.33% in control group from day 0 to day 8. A decrease in size of 10 to 19.9mm was seen in 46.66%of patients of VAC group and only 6.66% in control group. A decrease in size of more than 25mm was seen in 13.33% in VAC group. Similar studies were conducted by Argenta et al., Morykwas et al & Joseph et al [15] & these studies showed that VAC proved effective in shrinking of the diameter of the wound size and formation of healthy granulation tissue when compared to normal saline dressing methods. Russel et al [16] advocates that primary wound closure should be avoided in treatment of open Tibia fractures, whereas Veliskakis [17] described primary internal fixation and primary wound closure gives good results. Presently there is a tendency towards radical debridement immediate fracture stabilization and immediate definitive coverage [18-21].
There are several advantages of applying a Primary VAC to an open injury and these include,
Hence VAC can be applied after each debridement and irrigation until the wound is fit for a reconstructive procedure such as SSG or flap cover. VAC can be applied in a continuous or cyclical manner. The observation that intermittent cyclical treatment appears more effective than continuous therapy is interesting although the reasons for this are not fully understood. Two explanations were proposed by Philbeck et al. They suggested that intermittent cycling results in rhythmic perfusion of the tissue which is maintained because the process of capillary auto regulation is not activated. They also suggested that as cells which are undergoing mitosis must go through a cycle of rest, cellular component production and division, constant stimulation may cause the cells to „ignore‟ the stimulus and thus become ineffective. Intermittent stimulation allows the cells time to rest and prepare for the next cycle. For this reason, it is suggested that cyclical negative pressure should be used clinically.
The daily rental charges for a conventional VAC machine and consumables are significant. This has discouraged many from using the system. However, there have been some reports showing that the increased healing times and downgrading of required operations correlate to decreased overall costs of care. The dressing should also enable larger wounds to be treated in the community with minimal nursing care impact. Our study uses modified VAC dressing and decreases the overall cost on comparison with conventional VAC dressing. This would free up hospital beds permitting faster healing of operative patients and preventing waiting list buildup. VAC therapy is not the answer for all wounds; however, it can make a significant difference in many cases.
Limitations of the study:
Modified Vacuum assisted closure therapy appears to be a viable adjunct for the treatment of open musculoskeletal injuries. Application of sub atmospheric pressure after the initial debridement to the wounds results in an increase in local functional blood perfusion, an accelerated rate of granulation tissue formation, and decrease in tissue bacterial levels. Although traditional soft tissue reconstruction may still be required to obtain adequate coverage, the use of this device decreases their need overall.
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
