AUCTORES
Globalize your Research
Case Report
*Corresponding Author: Pateel Gnp, DNB (Anesthesiology), junior consultant anesthesiologist, Dept of anesthesiology, Rangadore memorial hospital, Bangalore, India.
Citation: Pateel Gnp. (2022). Anaesthetic and perioperative management of elderly female with post covid ARDS with comorbities undergoing emergency Laparotomy for obstructed umbilical hernia. International Journal of Clinical Case Reports and Reviews. 10(2); DOI: 10.31579/2690-4861/182
Copyright: © 2022 Pateel Gnp, This is an open access article distributed under the Creative Commons Attributiosn License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 07 October 2021 | Accepted: 29 December 2021 | Published: 05 January 2022
Keywords: laparotomy; covid-19 pneumonia; obstructed umbilical hernia; perioperative period
Elderly female with chronic hypertension, known case of atrial flutter on rate control medication who recently treated for COVID-19 pneumonia on oxygen support(PFR=190) came to emergency room with complaints of abdominal mass and pain associated with vomiting, not passing stools. Diagnosed to have obstructed umbilical hernia with extensive secondary bacterial pneumonia with ARDS (ASA-4E). COVID-19 RTPCR test negative. Taken up for emergency laparotomy under combined spinal and epidural anaesthesia (CSEA). Post operatively patient was managed in intensive care unit for 5days with oxygen, invasive lines, vasopressor support and epidural infusion. Post covid patients presenting for emergency surgery requires evaluation of surgical illness and post covid sequels like oxygen dependency, cytokine storm, secondary bacterial infection, ARDS, lung fibrosis renal and liver dysfunction. Atrial flutter in perioperative period may lead to haemodynamic instability and thromboembolic events resulting in significant morbidity and mortality. Laparotomy in these patient is challenge. Needs better analgesia perioperative period to prevent further respiratory deterioration.
A 81year old female with class 1 obesity known hypertension and atrial flutter, status post modified radical mastectomy for left carcinoma breast 20 years ago was admitted with complaint of mass per abdomen since 3 years which is associated abdomen pain, vomiting and not passing stools since 3days. Mass per abdomen in umbilical region started as small swelling, gradually progressive to present size, reducing by itself on lying down which is persistently present since 3days not reducing. Patient was on treatment with telmisartan-40mg, tab Amiodarone-100mg, tab diltiazem-10mg and tab frusemide-40mg. metabolic equivalents (METs) less than 4. Patient was recently treated for COVID 19 pneumonia for 10days and discharged on home oxygen 1 week ago was on 17th day of covid illness. Presently patient is on 5L/min oxygen with simple mask. CT severity score on 5th day of COVID illness was 11/25.
On examination patient conscious, oriented. Heart rate(HR) 82/min, Blood pressure(BP) 110/40, Saturation(SPO2) 85-88% on room air, 95% with 5L/min oxygen, respiratory rate(RR) 28-30/min. Per abdomen mass 8x6x6cm2 in umbilical region, oval shaped, soft irreducible in nature associated with diffuse distention and tenderness. Bowel sounds absent. Bilateral extensive crepitations heard on auscultation chest. Sequential organ failure assessment (SOFA) score-4/25. Airway mouth opening >3cm, Mallampatti class-2, edentulous.
Hb-15.4gm%,WBC-12840/cumm,Platelet-2.25lakhs,Creatinine 0.9mg/dL, BUN 62mg/dL, normal liver function test, albumin levels 3.0mg/dL, sodium 133, potassium 3.7, chloride 102mEq, coagulation profile normal with INR being 1.04. ECG showed normal sinus rhythm with RBBB, 2D echo sowed concentric LVH with ejection fraction 55%. Covid 19 RTPCR negative, chest x ray showed bilateral extensive infiltrates, CT abdomen is suggestive of obstructed umbilical hernia. Preoperative ABG showed lactate PH-7.33, PCO2-28, PO2-76, HCO3-18, lactate-2.1. Serum procalcitonin-14.6ng/ml,CRP-46mg/L,D-dimer-1274ng/mL. Surgical gastroenterologist advised for emergency laparotomy and proceeds.
Written informed for surgery was obtained. High risk and post-operative ICU care, ventilator support, prolonged hospitalization was explained. Patient was nil oral more than 8hours, 1 liter of ringer lactate bolus given; BP was improved to 130/72. Inj pantoprazole 40mg, in Odansetron 4mg IV given. In cefuroxime sulbactam 1.5g IV given after test dose. 2 pint of packed cells reserved (O positive). Foleys catheter and ryes tube inserted. Patient was continued with 5liter/min oxygen with simple mask. Patient is haemodynamically stable and coagulation parameters were normal hence decided to do case under combined spinal epidural anesthesia (CSEA).
Patient shifted to operation theatre with oxygen. Monitors connected and Basal vitals were noted. Under all aseptic precautions, under local anaesthesia in sitting epidural puncture done at L1-L2 space with 18G tuohy needle, loss of resistance at 3.5cm, 20G epidural catheter inserted fixed at 9cm. Inj lignocaine+adrenalin 2% 3ml test dose given. Spinal anaesthesia was given with 26G needle midline approach at L3-L4 space, clear CSF flow present. Inj bupivacaine 0.5% (Heavy) 2cc+ buprenorphine 60mcg given intrathecally. Vitals were stable. Analgesia, level and relaxation was adequate. Patient was started with epidural infusion of Inj ropivacaine 0.2% and fentanyl 2mcg/cc 5ml/hour. Patient had hypotension BP being 80/46 mmHg. Treated with fluid bolus and Inj phenylephrine 50mcg bolus. BP responded well. Haemodyamically stable throughout surgery.
Incision around 12cm extending up to T6. Large sac with rotated congested small intestine noted. Bowel loops reduction done, sac excised, wash given. Rectus sheath closed. Primary closure of the abdomen done. Total duration of surgery 2hour: 30mins. Total intravenous fluid given 3000ml. Total urine output 800ml. Blood loss approximately 400ml. Ryes tube drain 150ml.
Post-operatively patient shifted to ICU with 5L/min oxygen, post operatively patient was conscious, oriented hemodynamically stable. HR-98/min, BP-130/76, saturation 95%, respiratory rate 28/min. per abdomen soft, bowel sounds absent, RS b/l crepitations. Kept nil oral, continued with IV fluids 125ml/hr, antibiotics upgraded to piperacilllin+tazobactam. Analgesia continued with epidural infusion and intravenous paracetamol. Post-operative ABG done showing PH-7.34, PCO2-40.7, PO2-140, HCO3-21.5, lactate-1.68.
Post op day-1: Patient required more oxygen hence switched to 10L/min oxygen with NRBM. High coloured urine, postural hypotension, giddiness on ambulation, BP 80/40mmHg, lactate 2.40mmol/l. Screening ECHO showed collapsing IVC. Measures taken are telmisartan was withheld, 2liters bolus fluid, continued IVF 150ml/hour. Arterial line and central line secured and noradrenalin started to maintain BP. Epidural infusion stopped temporarily. SOFA Score progressed to 7/24. Thromboprophylaxis with clexane.
Post op day 2: HR-188/min, ECG- atrial flatter, reverted to sinus rhythm with inj amiodarone 150mg bolus, infusion started. Screening echo showed no significant changes. BP 130/50 with 2ml/hour nor adrenalin. Total fluid input 2325ml, total output 1840ml. Lactate-2mmol/l. clear adequate urine output. Epidural infusion restarted. Serum potassium was low, correction started. Incentive spirometry and breathing exercise started. Nor adrenalin tapered and stopped. Clear liquids started orally. ERAS protocol followed.
Post op day 3: patient was conscious, oriented. In sinus rhythm and haemodynamically stable. Oxygen tapered to 3L/min oxygen with nasal prongs. Lactate-1.4mmol/L. Chest X ray bilateral infiltrates reduced. Bowel movements present. Clear liquids and predigested feeds started. Ryes tube taken out. Patient ambulated. Amiodarone IV infusion stopped and switched to oral.
Post op day 4: on 2L/min oxygen, saturation 96%, haemodynamically stable. Orally taking. IV fluids reduced to 75ml/hour. Epidural and foleys catheter removed. Switched to IV analgesics. Shifted to ward with oxygen. Chest physiotherapy, incentive spirometry, ambulation with support was continued.
COVID-19 has multi systemic involvement with pneumonia, Myocarditis, gut ischemia, kidney injury, liver damage, shock, and imbalance in coagulation homeostasis (1). We report our experience of peri-operative anesthetic care of an elderly hypertensive lady with post covid with severe bilateral bacterial pneumonia moderate ARDS who developed obstructed umbilical hernia necessitating emergency Laparotomy.
Emergency laparotomy is a time sensitive surgery where a bleeder/septic focus requires emergent damage control surgery. Delays in surgical damage control in favor of optimization are deleterious[2, 3, 4]. Hence, the goal should be to judiciously optimize without delaying surgery and the extent of optimization should be determined by the surgical urgency. Our patient only has bilateral pneumonia with moderate ARDS with oxygen requirement, all other organ system functions were normal hence taken for surgery as early as possible.
While planning regional techniques, due considerations should be given to anticoagulation therapy and coagulopathy in covid 19 patients [5]. Surprisingly our patient was not on any anticoagulation therapy and did not have any coagulation abnormality both are more common in covid and post covid phase.
CSEA has fewer deleterious effects on respiratory function and dynamics compared with general anaesthesia. This preservation of respiratory function and better analgesia could reduce postoperative pulmonary complications in COVID-19 and post covid patients who may already have reduced respiratory function from COVID-19- associated pneumonia or acute respiratory distress syndrome. However, this approach requires a co-operative patient, an experienced surgeon, and a skilled anaesthesiologist and normal coagulation parameters.
The main problem of CSEA is accelerated hypotension due to sympathetic blockade, ventilatory changes due to higher sensory levels required, and diaphragmatic irritation leading to shoulder tip pain along with increased surgical duration. Our patient had transient hypotension which was treated with IV fluid bolus and phenylephrine 50mcg bolus doses.
The factors which delay recovery after major GI surgery are pain, lack of gastrointestinal function and immobility. Therefore postoperative management should include pain control, to promote gastrointestinal function and mobility as soon as possible [6,7] [40,41].ERAS is associated with more rapid recovery and shortened length of stay more than 30% and appears to be associated with reduced post-operative complications up to 50% [6].
We believe that CSEA can be used as a good alternative to general anesthesia in severe pneumonia, ARDS secondary to covid/post covid phase in geriatric, emergency and risk patients provided haemodynamically stable and normal coagulation. In our case, we preferred to apply CSEA instead of general anesthesia because of the negative effects of general anesthesia on respiratory functions due to the presence of pneumonia, oxygen support and poor respiratory reserve. Epidural analgesia post operatively gave better analgesia and helped early recovery in this case.
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.
