AUCTORES
Globalize your Research
Research Article
*Corresponding Author: Zbigniew Szkulmowski, MD, PhD Departament of Anesthesiology and Intensive Care, University Hospital No 1 in Bydgoszcz, Ul. Skłodowskiej Curie 9 85-001 Bydgoszcz, Poland.
Citation: Zbigniew Szkulmowski, Marcin Owczarek, Elżbieta Nurczyńska, Michalina Kołodziejczak, Przemysław Jasiewicz, et al, (2024), Disorders of blood oxygenation during extracorporeal membrane oxygenation for AH1N1 pneumonia in exacerbated chronic myeloid leukemia treated by initiation of chemotherapy, International Journal of Clinical Case Reports and Reviews, 19(1); DOI:10.31579/2690-4861/522
Copyright: © 2024, Zbigniew Szkulmowski. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 26 August 2024 | Accepted: 09 September 2024 | Published: 16 September 2024
Keywords: extracorporeal membrane oxygenation; mechanical ventilation; acute respiratory distress syndrome; chronic myeloid leukemia
Patients with severe acute respiratory distress syndrome require supportive treatment with mechanical ventilation with or without extracorporeal membrane oxygenation to maintain optimal oxygenation. Persistent inefficient blood oxygenation can be related to severity of clinical presentation, technical issues, or concomitant diseases. In this case report, man previously suffering from chronic myeloid leukemia received extracorporeal membrane oxygenation for influenza A virus subtype H1N1. Despite invasive oxygenation therapy, it was not possible to achieve amelioration of arterial blood oxygenation. After a differential diagnosis, pathological hyperleukocytosis was identified as a potential reason of oxygenation impairment, which improved after introduction of concomitant chemotherapy that lowered leukocytes count.
Acute respiratory distress syndrome (ARDS) represents a severe form of respiratory failure characterized by bilateral pulmonary infiltrates and hypoxemia [1]. While ARDS can arise from various etiologies, including infectious pathogens such as the influenza A virus subtype H1N1 (AH1N1), its management remains challenging, particularly in patients with underlying hematologic malignancies. Chronic myeloid leukemia (CML), a myeloproliferative disorder (MPD) characterized by the Philadelphia chromosome, poses additional complexities in the treatment of ARDS due to potential complications such as hyperleukocytosis. This case report presents the clinical course and management of a patient with CML who developed AH1N1-ARDS requiring ECMO. Also, it is highlights the diagnostic and therapeutic strategies employed to address refractory hypoxemia, with a focus on the role of hyperleukocytosis in exacerbating respiratory compromise.
An analysis of patient’s electronic and paper records was conducted. Response to treatment was closely monitored through serial arterial blood gas analysis, laboratory parameters, and clinical assessments. Improvement in oxygenation parameters and leukocyte counts served as primary outcome measures. The patient underwent multiple per day follow-up assessments to evaluate treatment response, disease progression, and potential complications. The Institutional Review Board (IRB) or equivalent ethics committee of the NCU did not approve this study because it was a retrospective case report involving a single patient. Furthermore, all data were anonymized to protect patient privacy, and the report was created solely for educational and informational purposes, adhering to ethical guidelines for case reporting without the need for formal IRB review. Patient written consent for the publication of the study was not received as he passed away.
A 42-year-old male was admitted to a University Hospital intensive care unit (ICU) due to increasing hypoxia and severe ARDS caused by viral AH1N1 pneumonia (confirmed by PCR test). The patient was previously managed for 1 day in a county hospital and was transferred to a hospital of a higher reference as his condition worsened. Additionally, he presented with exacerbation of chronic myeloid leukemia (CML) with hyperleukocytosis (360 000-480 000/mm3), detected by blood tests and bone marrow examination. At admission, the patient fulfilled all the criteria of severe ARDS and was treated with intensive conventional therapy consisting of mechanical ventilation, positioning therapy, and infection control [1, 2]. Antibiotic therapy consisting of imipemene/cilastatin, linezolid, caspofungine, colistine, sulfamethoxazole/trimethoprime, oseltamivir and acyclovir was carried out from the beginning until the 12th day of treatment, when oseltamivir was discontinued, and linezolid was switched to vancomycin. This composition of antibiotic therapy was continued unchanged until the end of the patient's treatment. The treatment plan included implementing ECMO if conventional therapy did not improve patient’s condition due to multiple relative contraindications: duration of mechanical ventilation, neoplastic disease, PaO2/FiO2 = 140-190 and oxygenation index OI = 15 – being outside the ranges recommended by the Polish Society of Anesthesia and Intensive Care[3]. His clinical condition improved for the first 8 days of ICU stay, allowing for consideration of extubation, followed by noninvasive ventilation within a short-term treatment plan. On the 9 th day of ICU stay, sudden aggravation of clinical condition, with increasing hypoxia prompted the decision of initiating veno-venous ECMO therapy that, unexpectedly, did not improve blood oxygenation (Table 1). Despite high flows of blood (4.6 L/min on centrifugal pomp) and gases (10 L of 100% O2/min on oxygenator), no more than PaO2 56 mmHg was achieved (from radial artery, Figure 1, point V) not allowing for induction of minimal, ultraprotective ventilation[4, 5]. ECMO parameters remained unchanged during the time of treatment: Blood flow on the centrifugal pump was set at 4 L/min (besides day 9, before chemotherapy, when it was set at 4.6 L/min) and gas flow on the oxygenator was set at 10 L/min of 100% L O2.
| Day in the ICU | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | 17 | 17 | |
| Day of ECMO | - | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | - | |
| Day of chemotherapy | - | - | 1 | 2 | 3 | 4 | 5 | - | - | - | - | |
| Leukocytes K/mm3 | 254 | 235 | 240 | 266 | 314 | 97 | 38 | 12 | 4,1 | 1,3 | 1,3 | |
| PO2 | I | 41 | 41 | |||||||||
| II | 577 | 550 | 484 | 487 | 450 | 430 | ||||||
| III | 97 | 101 | 103 | 74 | 73 | 152 | 193 | 357 | 302 | |||
| IV | 30 | 34 | 46 | 48 | 43 | 40 | 38 | 45 | ||||
| V | 60 | 58 | 54 | 65 | 84 | 70 | 62 | 57 | 66 | 61 | 99 | |
| FiO2 (ventilator) | 1 | 1 | 1 | 1 | 1 | 0,9 | 0,55 | 0,5 | 0,4 | 0,3 | 0,35 | |
| IPAP/EPAP | 22/18 | 22/18 | 22/18 | 22/15 | 25/15 | 25/15 | 20/13 | 17/10 | 17/8 | 14/8 | SIMV, 13/6 Vt 0,45 | |
| Oxygenation index OI | 33,3 | 34,5 | 37,0 | 28,5 | 22,0 | 23,8 | 14,6 | 11,8 | 8,2 | 5,4 | 3,4 | |
Table 1: Modification of the parameters of gas exchange (partial pressure of oxygen PO2) in different places of blood samples aspiration and BGA, respiratory parameters set on the ventilator (FiO2, inspiratory pressure IPAP, expiratory pressure EPAP) during BIPAP ventilation and oxygenation index OI on consequent days of chemotherapy. Oxygenation index OI = FiO2x PAWmean/PaO2, where PAWmean- mean airway pressure
As the arterial oxygenation did not improve, PO2 was analysed on different levels of the patient’s circulatory system and ECMO system (Figure 1) and massive oxygen consumption due to hyperleukocytosis was suspected to be the underlying reason [6]. Leukapheresis was conducted on day 9 and 10 of the ICU stay, however, it had no cytoreduction effect. Evaluating potential benefits and risks within a multidisciplinary team, a 5-day chemotherapy, based on methylprednisolone, fludrabine, fasturtek and rituximab was introduced on the 10th day of the ICU stay. From day 4 of chemotherapy leukocytosis declined, preceded by improvement of oxygenation, which allowed for induction of minimal ventilation. To confirm the influence of hyperleukocytosis on the patient’s oxygenation, blood was sampled from different, accessible points of the patient’s circulatory system and of the ECMO circuit (Figure 1). The ECMO therapy was terminated 9 days after cannulation, when patient had normal PaO2 levels, at FiO2 0,35 and low mechanical ventilation pressures, were possible (Table 1). ECMO therapy was interrupted after an abrupt deterioration of neurological condition secondary to intracranial hemorrhage, which was evacuated by neurosurgeons the same day. The patient’s neurological condition continued to deteriorate and on day 23 of ICU treatment brain death was confirmed.
Central Picture. The placement of cannulas insertion and sample aspiration for blood gases analysis.
I. The inflow of venous blood to the oxygenator, II. The outflow of the oxygenated blood from the oxygenator, III. The right atrium (from hemofiltration cannula, distal channel), IV. Superior vena cava (from the central venous catheter, distal channel), V. Radial artery. HCF – hemofiltration catheter, CVC – central venous catheter. Blood was aspirated to ECMO by 2 27F catheters from the right internal jugular vein and left iliac vein and returned to the right atrium by right iliac vein and inferior vena cava.
In severe ARDS, ECMO may fail to improve oxygenation due to factors like hyperleukocytosis, as seen in a 42-year-old CML patient with AH1N1-ARDS, whose condition improved post-chemotherapy.
The ineffectiveness of ECMO in ameliorating oxygenation during hyperleukocytosis could had been caused by pathological oxygen consumption in CML. After excluding the technical reasons for abnormal blood oxygenation, we considered the abovementioned phenomenon, previously described by Chillar [6]. To validate this hypothesis, we compared PO2 measured in blood samples taken from different places of ECMO machine and circulatory system of the patient
The oxygen consumption cascade in a blood sample before and after cytoreduction was not performed (PO2 measurement immediately after sampling and after every 1 minute) as it was done by Chillar [6] due to immediate leukocyte sedimentation in blood samples, resulting in the inability to maintain blood in a liquid state allowing PO2 measurement. The improvement of PO2 on days 2-3 of chemotherapy, before observed leukocyte reduction, can result from impairing the metabolic function of leukocytes and its oxygen intake before the definitive cell destruction [7, 8]. The effect of antimicrobial treatment does not appear to be temporally related to improved arterial oxygenation. No improvement in oxygenation in the lungs was observed until the start of chemotherapy. Modification of antibiotic therapy by the inclusion of vancomycin also seems to have no effect on the improvement of oxygenation, as a significant reduction in OI was observed already on the 11th day of treatment - 1 day after the initiation of chemotherapy but before the inclusion of vancomycin. Antibiotics in practically unchanged composition were used from the beginning throughout the patient's treatment. Only on the 12th day of treatment, oseltamivir was discontinued and vancomycin was introduced, while linezolid was discontinued. Previous reports described attempts on leukapheresis in patients treated with ECMO for respiratory failure caused by hyperleukocytosis, which enabled efficient oxygenator function. One case report presented a patient receiving induction chemotherapy for acute myelogenous leukemia concomitantly undergoing venovenous ECMO that also experienced subarachnoid hemorrhage. To our knowledge, no previous report addressed a clinical case of concomitant ARDS due to AH1N1 pneumonia with concomitant hyperleukocytosis caused by CML, requiring ECMO therapy and chemotherapy due to leukapheresis futility. The current case shows that aggressive and multimodal approach in complicated patients could be effective in the treatment of critical cases. Closer coagulation monitoring and management would be required.
Some limitations of the current case report can be outlined. PO2 measurements were not done at the end of the ECMO arterial line (before entering the iliac vein), but at the beginning of the line (after the oxygenator) (Figure 1, point II). Comparing PO2 at the length of the ECMO arterial line could indicate the existence of a significant fall of O2 inside the cannula, where no other sources of oxygen consumption besides blood cells can exist. While the interpretation of the results of PO2 measurements in the other points, accessible for blood sampling (Fig 1), is not evident, the procedure can be hazardous, especially when full anticoagulation therapy is obligatory, due to the risk of perforating the cannula resulting in the need of replacement.
PO2 in the right atrium (point III) is a function of different PO2 in blood flows form the oxygenator (PO2 around 500 mm Hg, constant flow 4.6 L/min) and great veins (PO2 around 40 Hg, flow not possible to measure, undoubtedly variable in critically ill). So the proportions of the two blood flows were variable and the resulting PO2 was variable as well. The mean of PO2 from several samples was analyzed to overcome the problem. The difference of PO2 levels between right atrium (point III) and in the radial artery could be the best parameter reflecting blood O2 consumption. Between the two points, there are no tissues consuming O2, besides the blood itself. PO2 is physiologically lowered by venous admixture from the bronchial arteries (but there is no reason that its flow changed during treatment) and pathologically in the case of congenital heart defect (excluded by the transesophageal echocardiography). Right-left heart blood flow (if present) could even increase the radial artery PO2 because of high oxygen levels (around 100-180 mm Hg) in the right atrium blood during ECMO therapy.
The metabolic activity of the leukemic infiltrates which are likely to occur in the lungs, and its influence on arterial oxygenation is unknown and difficult to measure.
While oxygenation index OI is not a parameter adapted for assessing oxygenation during ECMO therapy, at unchanged flows of blood (at the centrifugal pump) and gases (on oxygenator) it can correctly reflect the improvement of gas exchange[9, 10].
The clinical course, time correlation between oxygenation improvement and the decrease in the number of leukocytes can indicate hyperleukocytosis as a dominant factor determining the problems of blood oxygenation and the lack of efficacy of ECMO therapy. That can indicate the necessity to consider cytoreduction therapy in leukemic patients with hyperleukocytosis treated for ARDS.
The authors declare that they have no conflict of interest.
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.
